=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417229196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2012
-----------------------------------------------------
Last Update Date | 10/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 ALABAMA AVE
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36701-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-875-9790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 WOODMONT BLVD STE 120
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-5249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-550-8774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | AARON KRATOHVIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-550-8760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 019
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------