Healthcare Provider Details

I. General information

NPI: 1487629101
Provider Name (Legal Business Name): ALABAMA SPORTS MEDICINE AND ORTHO CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 ST VINCENTS DRIVE SUITE 415
BHAM AZ
35205
US

IV. Provider business mailing address

2800 UNIVERSITY BLVD SUITE 100
BHAM AZ
35233
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-3000
  • Fax: 205-930-0008
Mailing address:
  • Phone: 205-939-3000
  • Fax: 205-930-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. H MICHAEL IMMEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-939-3000