Provider Demographics
NPI:1073248290
Name:ORTHOSPORTS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:W
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-939-0447
Mailing Address - Street 1:833 SAINT VINCENTS DR STE 403
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1614
Mailing Address - Country:US
Mailing Address - Phone:205-939-0447
Mailing Address - Fax:
Practice Address - Street 1:5295 PRESERVE PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4701
Practice Address - Country:US
Practice Address - Phone:205-781-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOSPORTS ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty