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William
E
Riley
MD
Contract Details
Birmingham Surgical
Facility name
Provider ID
P000001466
NPI
1457311250
Tax ID
630677675
Effective Date
12/15/2006
Last Updated
3/26/2014
Direct Contract
Yes
Term Date
4/17/2013
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
833 Princeton Avenue Southwest POB III, Suite 200-A
Birmingham, AL 35211
United States
County
Jefferson
Phone
2057863096
(
Phone
)
Billing Details
Address
2022 Brookwood Medical Center Drive
Suite 313
Birmingham, AL 35209
Billing Phone
2058772910
Specialty Type
Surgery, General
Map
Address