MEDICARE: ALLEN ORTHOPEDICS,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	207X00000X	Orthopaedic Surgery Physician	MD9362	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200025494	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1972866457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN ORTHOPEDICS,LLC

Provider Business Mailing Address
First Line	:	5613 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-4210
Country	:	US
Telephone Number	:	251-665-5127
Fax Number	:	215-665-5159

Provider Business Practice Location Address
First Line	:	5613 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-4210
Country	:	US
Telephone Number	:	251-665-5127
Fax Number	:	215-665-5159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HERBERT VICTOR ALLEN III
Credential	:	M.D.
Telephone Number	:	251-665-5127

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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