MEDICARE: TUSCALOOSA ORTHOPEDIC & JOINT INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1467865758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUSCALOOSA ORTHOPEDIC & JOINT INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	100 RICE MINE ROAD LOOP STE 205
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2419
Country	:	US
Telephone Number	:	205-391-4440
Fax Number	:	205-391-4441

Provider Business Practice Location Address
First Line	:	100 RICE MINE ROAD LOOP STE 205
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2419
Country	:	US
Telephone Number	:	205-391-4440
Fax Number	:	205-391-4441

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BRYAN R KING
Credential	:	MD
Telephone Number	:	205-391-4440

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	05/07/2020

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