1487629101 NPI number — ALABAMA SPORTS MEDICINE AND ORTHO CENTER

Table of content: (NPI 1487629101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487629101 NPI number — ALABAMA SPORTS MEDICINE AND ORTHO CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA SPORTS MEDICINE AND ORTHO CENTER
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:
1487629101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BHAM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
35233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-939-3000
Provider Business Mailing Address Fax Number:
205-930-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 ST VINCENTS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 415
Provider Business Practice Location Address City Name:
BHAM
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-3000
Provider Business Practice Location Address Fax Number:
205-930-0008
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IMMEL
Authorized Official First Name:
H
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
205-939-3000

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0310040001 . This is a "CIGNA GOVERNMENT SERVICES" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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