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General NPI Number Information
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NPI Number | 1184438855
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Entity Type | Organization
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Legal Business Name | ORTHOSPORTS1ST PC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 5510 PROMENADE POINT PKWY NW # 160
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City | MADISON
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State | AL
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Zip | 35758-6702
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Country | US
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Telephone | 256-289-8470
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Fax | 256-993-3096
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Provider Business Mailing Address
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Address Line | PO BOX 830525 DEPARTMENT# OWC 24
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City | BIRMINGHAM
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State | AL
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Zip | 35283-0525
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Country | US
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Telephone | 205-352-2911
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Fax | 205-352-2910
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK COVIN
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Credential |
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Telephone | 205-352-2911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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