1508931866 NPI number — ALABAMA ORTHOPAEDIC CLINIC, PC

Table of content: (NPI 1508931866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508931866 NPI number — ALABAMA ORTHOPAEDIC CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA ORTHOPAEDIC CLINIC, 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:
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:
1508931866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 SPRINGHILL MEMORIAL DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-410-3600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 56 ST STEPHENS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATOM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36518-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-847-2223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDGENS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-410-3600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  056904 , 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: J552 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




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