1043388374 NPI number — DECATUR ORTHOPAEDICS SPECIALISTS, P.C.

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 1043388374 NPI number — DECATUR ORTHOPAEDICS SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECATUR ORTHOPAEDICS SPECIALISTS, P.C.
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:
1043388374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601-0776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-353-8811
Provider Business Mailing Address Fax Number:
256-301-6196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3402 VESTAVIA CIR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35603-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-318-8811
Provider Business Practice Location Address Fax Number:
256-350-3632
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOLORIO
Authorized Official First Name:
JAY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
256-318-8811

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  13433 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 13433 , 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: 009972325 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529905110 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051060664 . This is a "BCBS DECATUR OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529905120 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000060664 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000092359 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051092359 . This is a "BCBS HARTSELLE OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com