1649399502 NPI number — ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649399502 NPI number — ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649399502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODMONT BLVD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-5249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-550-8774
Provider Business Mailing Address Fax Number:
615-454-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 WESTEND CT
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-5451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-737-3000
Provider Business Practice Location Address Fax Number:
334-737-3014
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRATOHVIL
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
615-550-8760

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  019 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-97405 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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