Healthcare Provider Details

I. General information

NPI: 1568041671
Provider Name (Legal Business Name): ORTHOSPORTS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 ROCKY RIDGE RD
HOOVER AL
35216-5138
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 403
BIRMINGHAM AL
35205-1614
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0477
  • Fax: 205-939-0418
Mailing address:
  • Phone: 205-939-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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