1952577892 NPI number — ORTHOPEDIC SURGERY SPECIALISTS, INC.

Table of content: (NPI 1952577892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952577892 NPI number — ORTHOPEDIC SURGERY SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC SURGERY SPECIALISTS, 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:
1952577892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 US HIGHWAY 43
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35594-5062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-487-1111
Provider Business Mailing Address Fax Number:
205-487-1114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15243 GREENFIELD DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35613-2899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-233-2332
Provider Business Practice Location Address Fax Number:
256-216-3579
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BOYETT
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
205-487-1111

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  DO-530 , 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: 1326199530 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51591148 . This is a "BLUE CROSS AND BLUE SHIELD OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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