Provider Demographics
NPI:1043246895
Name:ACTION ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:ACTION ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MACVICAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:334-699-5462
Mailing Address - Street 1:2191 E MAIN ST, STE 1
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3016
Mailing Address - Country:US
Mailing Address - Phone:334-699-5462
Mailing Address - Fax:334-699-5623
Practice Address - Street 1:2191 E MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3016
Practice Address - Country:US
Practice Address - Phone:334-699-5462
Practice Address - Fax:334-699-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA306271899AMedicaid
AL5718430001OtherCIGNA GOVERNMENT SERVICES
AL009938579Medicaid
AL5718430001Medicare NSC