Healthcare Provider Details

I. General information

NPI: 1740331347
Provider Name (Legal Business Name): DECATUR ORTHOPAEDIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/09/2024
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 14TH AVE SE STE 300
DECATUR AL
35601-3368
US

IV. Provider business mailing address

1107 14TH AVE SE STE 300
DECATUR AL
35601-3368
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-0362
  • Fax: 256-355-9779
Mailing address:
  • Phone: 256-350-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARSHA B BUCHANAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 256-350-0362