Provider Demographics
NPI:1114066560
Name:JIM MYERS ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:JIM MYERS ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:JOHNSTON
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-246-9789
Mailing Address - Street 1:600 UNIVERSITY BLVD E
Mailing Address - Street 2:STE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2067
Mailing Address - Country:US
Mailing Address - Phone:205-248-8993
Mailing Address - Fax:205-248-8471
Practice Address - Street 1:600 UNIVERSITY BLVD E
Practice Address - Street 2:STE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2067
Practice Address - Country:US
Practice Address - Phone:205-248-8993
Practice Address - Fax:205-248-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier