MEDICARE: WEST ALABAMA ORTHOPAEDIC AND SPORTS MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	00022472	AL
2	208100000X	Physical Medicine & Rehabilitation Physician	DO932	AL
3	207X00000X	Orthopaedic Surgery Physician	00009008	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760420384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST ALABAMA ORTHOPAEDIC AND SPORTS MEDICINE, PC

Provider Business Mailing Address
First Line	:	PO BOX 840
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35476-0840
Country	:	US
Telephone Number	:	205-333-8800
Fax Number	:	205-333-8406

Provider Business Practice Location Address
First Line	:	1325 MCFARLAND BLVD
Second Line	:	SUITE 102
City	:	NORTHPORT
State	:	AL
Zip	:	35476-3270
Country	:	US
Telephone Number	:	205-333-8800
Fax Number	:	205-333-8406

Authorized Official
Title or Position	:	INSURANCE SPECIALIST
Name	:	MRS. KATHRYN BANKS PRITCHETT
Credential	:
Telephone Number	:	205-330-4206

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/04/2009

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Directions to “WEST ALABAMA ORTHOPAEDIC AND SPORTS MEDICINE, PC ” Practice Location

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