1669552329 NPI number — STRATUS ORTHOPEDIC SUPPLY, INC.

Table of content: (NPI 1669552329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669552329 NPI number — STRATUS ORTHOPEDIC SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATUS ORTHOPEDIC SUPPLY, 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:
1669552329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3021 LORNA RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-4587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-822-2400
Provider Business Mailing Address Fax Number:
205-822-5710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 LORNA RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-4587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-822-2400
Provider Business Practice Location Address Fax Number:
205-822-5710
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-822-2400

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 604 , 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: 515-24272 . This is a "MEDICAL O&P" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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