Provider Demographics
NPI:1114226438
Name:ORTHOSPORTS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-939-0447
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:BLDG. 3, SUITE 403
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-939-0447
Mailing Address - Fax:205-939-0418
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:BLDG. 3, 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:205-939-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6541480003Medicare NSC
AL6541480002Medicare NSC
AL6541480001Medicare NSC
AL6541480004Medicare NSC