1316933617 NPI number — ALABAMA ORTHOTICS & PROSTHETICS, INC.

Table of content: (NPI 1316933617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316933617 NPI number — ALABAMA ORTHOTICS & PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA ORTHOTICS & PROSTHETICS, 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:
MISSISSIPPI ORTHOTICS & PROSTHETICS,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:
1316933617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 CLIFF GOOKIN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38801-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-396-4670
Provider Business Mailing Address Fax Number:
662-396-4677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 HIGHWAY 72 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38834-9398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-396-4670
Provider Business Practice Location Address Fax Number:
662-396-4677
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-536-5625

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3160016 . This is a "BCBS OF TENNESSEE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00440966 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20423 . This is a "TLC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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