Provider Demographics
NPI:1043262124
Name:THE ORTHOPEDIC CENTERS
Entity Type:Organization
Organization Name:THE ORTHOPEDIC CENTERS
Other - Org Name:SPARKS ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-546-8127
Mailing Address - Street 1:3102 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5804
Mailing Address - Country:US
Mailing Address - Phone:256-546-8127
Mailing Address - Fax:256-547-6720
Practice Address - Street 1:3102 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5804
Practice Address - Country:US
Practice Address - Phone:256-546-8127
Practice Address - Fax:256-547-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13891207X00000X
AL08437207X00000X
AL23975207X00000X
AL24950207X00000X
AL1034563363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH773OtherMEDICARE GROUP #
ALH773OtherMEDICARE GROUP #
AL6464970001OtherMEDICARE PTAN FOR DME SUPPLIER
ALH773OtherMEDICARE GROUP #
ALC75517Medicare UPIN
ALI70139Medicare UPIN
ALC75517Medicare UPIN