Provider Demographics
NPI:1902905706
Name:ALABAMA ORTHOPAEDIC SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:ALABAMA ORTHOPAEDIC SURGICAL SPECIALISTS
Other - Org Name:ORTHOPAEDIC SPORTS MEDICINE CLINIC OF ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-822-9595
Mailing Address - Street 1:200 MONTGOMERY HIGHWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-822-9595
Mailing Address - Fax:205-822-4733
Practice Address - Street 1:200 MONTGOMERY HIGHWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-822-9595
Practice Address - Fax:205-822-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9333006085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5264880001Medicare NSC