Healthcare Provider Details

I. General information

NPI: 1952197972
Provider Name (Legal Business Name): CROTWELL ORTHOPEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HILLCREST RD STE B
MOBILE AL
36695-3904
US

IV. Provider business mailing address

720 HILLCREST RD STE B
MOBILE AL
36695-3904
US

V. Phone/Fax

Practice location:
  • Phone: 251-272-4934
  • Fax: 251-460-5457
Mailing address:
  • Phone: 512-724-9342
  • Fax: 251-460-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA FREENY
Title or Position: CONTRACTING AGENT
Credential:
Phone: 251-222-9319