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Thomas
A
Wilson
Jr
MD
Contract Details
Neurosurgical Associates
Facility name
Provider ID
P000001890
NPI
1942397971
Tax ID
630576431
Effective Date
3/9/1992
Last Updated
8/16/2018
Direct Contract
Yes
Term Date
8/13/2018
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
800 St. Vincent's Drive Suite 700
Birmingham, AL 35205
United States
County
Jefferson
Phone
2059338981
(
Phone
)
Billing Details
Address
800 St. Vincent's Drive
Suite 700
Birmingham, AL 35205
Billing Phone
2059338981
Specialty Type
Surgery, Neurological
Map
Address