Healthcare Provider Details

I. General information

NPI: 1417229196
Provider Name (Legal Business Name): ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALABAMA AVE
SELMA AL
36701-4622
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 120
NASHVILLE TN
37205-5249
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-9790
  • Fax:
Mailing address:
  • Phone: 615-550-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number019
License Number StateAL

VIII. Authorized Official

Name: AARON KRATOHVIL
Title or Position: CONTROLLER
Credential:
Phone: 615-550-8760