Provider Demographics
NPI:1134438898
Name:ABC ORTHOTICS & PROSTHETICS CULLMAN, LLC
Entity type:Organization
Organization Name:ABC ORTHOTICS & PROSTHETICS CULLMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEISHA
Authorized Official - Middle Name:MULLINS
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMF,CPOA
Authorized Official - Phone:256-775-6041
Mailing Address - Street 1:501 MAIN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-4728
Mailing Address - Country:US
Mailing Address - Phone:256-775-6041
Mailing Address - Fax:256-775-6052
Practice Address - Street 1:501 MAIN AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4728
Practice Address - Country:US
Practice Address - Phone:256-775-6041
Practice Address - Fax:256-775-6058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC ORTHOTICS & PROSTHETICS CULLMAN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15827335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000052115Medicaid