Provider Demographics
NPI:1215206099
Name:ORTHOPAEDIC SPORTS MEDICINE CLINIC OF ALABAMA, P.C.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPORTS MEDICINE CLINIC OF ALABAMA, P.C.
Other - Org Name:ALABAMA ORTHOPAEDIC SURGICAL SPECIALISTS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-822-9595
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:200 MONTGOMERY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1842
Practice Address - Country:US
Practice Address - Phone:205-822-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SPORTS MEDICINE CLINIC OF ALABAMA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site