Provider Demographics
NPI:1245426683
Name:LOTT SPINE & SPORTS, INC
Entity Type:Organization
Organization Name:LOTT SPINE & SPORTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-822-3333
Mailing Address - Street 1:2010 PATTON CHAPEL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5782
Mailing Address - Country:US
Mailing Address - Phone:205-822-3333
Mailing Address - Fax:
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-822-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD19369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG18344Medicare UPIN