Provider Demographics
NPI:1548256621
Name:ALABAMA ORTHOTICS & PROSTHETICS,INC.
Entity type:Organization
Organization Name:ALABAMA ORTHOTICS & PROSTHETICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-536-5625
Mailing Address - Street 1:1021 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3921
Mailing Address - Country:US
Mailing Address - Phone:256-308-0200
Mailing Address - Fax:256-308-0700
Practice Address - Street 1:1021 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3921
Practice Address - Country:US
Practice Address - Phone:256-308-0200
Practice Address - Fax:256-308-0700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALABAMA ORTHOTICS & PROSTHETICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-01106OtherBCBS OF ALABAMA
AL105698Medicaid
AL105698Medicaid