MEDICARE: BHC - COMPREHENSIVE WOUND CARE CLINIC AT PRINCETON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558325712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHC - COMPREHENSIVE WOUND CARE CLINIC AT PRINCETON

Provider Business Mailing Address
First Line	:	833 PRINCETON AVE SW
Second Line	:	POB III; SUITE 210
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-1323
Country	:	US
Telephone Number	:	205-783-3740
Fax Number	:	205-783-3739

Provider Business Practice Location Address
First Line	:	833 PRINCETON AVE SW
Second Line	:	POB III; SUITE 210
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-1323
Country	:	US
Telephone Number	:	205-783-3740
Fax Number	:	205-783-3739

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VALETA D NEAL
Credential	:
Telephone Number	:	205-715-5901

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	09/21/2015

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