Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW POB III; SUITE 210
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

833 PRINCETON AVE SW POB III; SUITE 210
BIRMINGHAM AL
35211-1323
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-3740
  • Fax: 205-783-3739
Mailing address:
  • Phone: 205-783-3740
  • Fax: 205-783-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VALETA D NEAL
Title or Position: PRESIDENT
Credential:
Phone: 205-715-5901