Provider Demographics
NPI:1033260880
Name:SPORTS MEDICINE & ORTHOPEDIC SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SPORTS MEDICINE & ORTHOPEDIC SPECIALISTS, P.C.
Other - Org Name:BAPTIST SPORTS MEDICINE & ORTHOPEDIC SPECIALISTS, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-595-6757
Mailing Address - Street 1:880 MONTCLAIR RD
Mailing Address - Street 2:SUITE 577
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1972
Mailing Address - Country:US
Mailing Address - Phone:205-595-6757
Mailing Address - Fax:205-595-0472
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 577
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-595-6757
Practice Address - Fax:205-595-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
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