Healthcare Provider Details

I. General information

NPI: 1922272624
Provider Name (Legal Business Name): EAST ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PEPPERELL PKWY BLD. 5
OPELIKA AL
36801-5452
US

IV. Provider business mailing address

2000 PEPPERELL PKWY BLD. 5
OPELIKA AL
36801-5452
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-2663
  • Fax: 334-528-2669
Mailing address:
  • Phone: 334-528-2663
  • Fax: 334-528-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL PRICE
Title or Position: CFO
Credential:
Phone: 334-528-3008