1417229196 NPI number — ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.

Table of content: (NPI 1417229196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417229196 NPI number — ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, 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:
6
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:
1417229196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODMONT BLVD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-5249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-550-8774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 ALABAMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-9790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KRATOHVIL
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
615-550-8760

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  019 , 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: 000050003 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0082-0000002 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-50003 . This is a "BLUE CROSS/BLUE SHIELD OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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