=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730701673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOSPORTS1ST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2020
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1031 BROCKS GAP PKWY STE 185
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244-4078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-352-2911
-----------------------------------------------------
Fax | 205-352-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1031 BROCKS GAP PKWY STE 185
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244-4078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-352-2911
-----------------------------------------------------
Fax | 205-352-2910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | MARK COVIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-352-2911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------