Provider Demographics
NPI:1114215068
Name:ORTHOSPORTS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES, LLC
Other - Org Name:ORTHOSPORTS ASSOCIATES, LLC - ST. VINCENT'S BIRMINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-838-3090
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 403
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-939-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty