Provider Demographics
NPI:1073620886
Name:ALABAMA ORTHOPEDIC INSTITUTE, INC.
Entity Type:Organization
Organization Name:ALABAMA ORTHOPEDIC INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-734-4700
Mailing Address - Street 1:1908 CHEROKEE AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5502
Mailing Address - Country:US
Mailing Address - Phone:256-734-4700
Mailing Address - Fax:256-736-1458
Practice Address - Street 1:1908 CHEROKEE AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-734-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051510407Medicaid
158863807OtherJENNIFER KNOWLTON - PHYSI
AL051510407Medicaid
051510407Medicare PIN
AL5246740001Medicare NSC