1588051197 NPI number — STANFORD ORTHOPEDICS, 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 1588051197 NPI number — STANFORD ORTHOPEDICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANFORD ORTHOPEDICS, 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:
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:
1588051197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 US HIGHWAY 43
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35594-5062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-487-1111
Provider Business Mailing Address Fax Number:
205-487-1114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15243 GREENFIELD DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35613-2899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-233-2332
Provider Business Practice Location Address Fax Number:
256-216-3579
Provider Enumeration Date:
04/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
STANFORD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-712-2882

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  DO.1414 , 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)





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