MEDICARE: ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE ASSOC

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	174400000X	Specialist	00008637	AL

General Provider Information

NPI Number	:	1992973408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE ASSOC

Provider Business Mailing Address
First Line	:	242 WINTON M BLOUNT LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3501
Country	:	US
Telephone Number	:	334-395-5800
Fax Number	:	334-395-5880

Provider Business Practice Location Address
First Line	:	242 WINTON M BLOUNT LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3501
Country	:	US
Telephone Number	:	334-395-5800
Fax Number	:	334-395-5880

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DEBBIE JEAN HARKNESS
Credential	:
Telephone Number	:	334-395-5800

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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