1912044512 NPI number — ALABAMA ORTHOPEDIC CARE PC

Table of content: (NPI 1912044512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912044512 NPI number — ALABAMA ORTHOPEDIC CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA ORTHOPEDIC CARE PC
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:
DARRELL J POTTER, MD
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:
1912044512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1018 S BRUNDIDGE ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36081-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-566-8881
Provider Business Mailing Address Fax Number:
334-566-7785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 S BRUNDIDGE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36081-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-566-8881
Provider Business Practice Location Address Fax Number:
334-566-7785
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
JACK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-566-8881

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  21790 , 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: POO203874 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: PO000041005 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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