1487629101 NPI number — ALABAMA SPORTS MEDICINE AND ORTHO CENTER

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 1487629101 NPI number — ALABAMA SPORTS MEDICINE AND ORTHO CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA SPORTS MEDICINE AND ORTHO CENTER
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:
Provider Other Organization Name Type Code:
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:
1487629101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BHAM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
35233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-939-3000
Provider Business Mailing Address Fax Number:
205-930-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 ST VINCENTS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 415
Provider Business Practice Location Address City Name:
BHAM
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-3000
Provider Business Practice Location Address Fax Number:
205-930-0008
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IMMEL
Authorized Official First Name:
H
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
205-939-3000

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0310040001 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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