Provider Demographics
NPI:1013227222
Name:ORTHOPAEDIC SPECIALISTS OF ALABAMA, PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF ALABAMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-702-7536
Mailing Address - Street 1:4295 CROMWELL RD.
Mailing Address - Street 2:STE. 308
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2163
Mailing Address - Country:US
Mailing Address - Phone:423-702-7536
Mailing Address - Fax:423-877-5855
Practice Address - Street 1:720 MONTCLAIR RD.
Practice Address - Street 2:STE. 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1964
Practice Address - Country:US
Practice Address - Phone:205-591-2516
Practice Address - Fax:205-591-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528201850Medicaid
G171Medicare PIN