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General NPI Number Information
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NPI Number | 1316933617
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Entity Type | Organization
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Legal Business Name | ALABAMA ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 3205 HIGHWAY 72 W
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City | CORINTH
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State | MS
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Zip | 38834-9398
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Country | US
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Telephone | 662-396-4670
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Fax | 662-396-4677
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Provider Business Mailing Address
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Address Line | 1501 CLIFF GOOKIN BLVD
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City | TUPELO
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State | MS
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Zip | 38801-6401
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Country | US
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Telephone | 662-396-4670
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Fax | 662-396-4677
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JERRY O. SWANSON
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Credential | C.P., L.P.
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Telephone | 256-536-5625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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