Healthcare Provider Details

I. General information

NPI: 1003802893
Provider Name (Legal Business Name): NORTHEAST ALABAMA PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LEIGHTON AVE STE 200
ANNISTON AL
36207-5762
US

IV. Provider business mailing address

731 LEIGHTON AVE STE 200
ANNISTON AL
36207-5762
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5664
  • Fax: 256-231-8664
Mailing address:
  • Phone: 256-235-5664
  • Fax: 256-231-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number010
License Number StateAL

VIII. Authorized Official

Name: RICK PARTAIN
Title or Position: OWNER
Credential: CPO
Phone: 256-549-0064