Healthcare Provider Details

I. General information

NPI: 1568550168
Provider Name (Legal Business Name): ORTHOTIC CENTER OF WEST ALABAMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MCFARLAND BLVD
NORTHPORT AL
35476-3374
US

IV. Provider business mailing address

945 MCFARLAND BLVD
NORTHPORT AL
35476-3374
US

V. Phone/Fax

Practice location:
  • Phone: 205-339-4900
  • Fax: 205-339-4976
Mailing address:
  • Phone: 205-339-4900
  • Fax: 205-339-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN TIMOTHY BUSH
Title or Position: OWNER-PRESIDENT
Credential: C-PED
Phone: 205-339-4900