Healthcare Provider Details

I. General information

NPI: 1114226438
Provider Name (Legal Business Name): ORTHOSPORTS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR BLDG. 3, SUITE 403
BIRMINGHAM AL
35205-1606
US

IV. Provider business mailing address

833 SAINT VINCENTS DR BLDG. 3, SUITE 403
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0447
  • Fax: 205-939-0418
Mailing address:
  • Phone: 205-939-0447
  • Fax: 205-939-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANE BUGGAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-939-0447