Healthcare Provider Details

I. General information

NPI: 1225608797
Provider Name (Legal Business Name): ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10382 EXPRESS DR
GULFPORT MS
39503-4600
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 400
NASHVILLE TN
37205-5217
US

V. Phone/Fax

Practice location:
  • Phone: 228-539-0034
  • Fax:
Mailing address:
  • Phone: 615-864-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRADFORD GARDNER
Title or Position: COO
Credential:
Phone: 615-550-8783