Provider Demographics
NPI:1730701673
Name:ORTHOSPORTS 1ST, PC
Entity type:Organization
Organization Name:ORTHOSPORTS 1ST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-352-2911
Mailing Address - Street 1:1031 BROCKS GAP PKWY STE 185
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4078
Mailing Address - Country:US
Mailing Address - Phone:205-352-2911
Mailing Address - Fax:205-352-2910
Practice Address - Street 1:1031 BROCKS GAP PKWY STE 185
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4078
Practice Address - Country:US
Practice Address - Phone:205-352-2911
Practice Address - Fax:205-352-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL163WX0800XOtherTAXONOMY