Healthcare Provider Details

I. General information

NPI: 1659972743
Provider Name (Legal Business Name): ORTHOSPORTS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MEDICAL PLAZA DRIVE SUITE 220
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

833 ST. VINCENT'S DRIVE BUILDING 3, SUITE 403
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3090
  • Fax:
Mailing address:
  • Phone: 205-939-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LORI W SILLS
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-939-0447