Provider Demographics
NPI:1356320428
Name:ALABAMA PROSTHETICS AND ORTHOTICS, INC.
Entity Type:Organization
Organization Name:ALABAMA PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:POWERS-WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, CPED
Authorized Official - Phone:334-286-9919
Mailing Address - Street 1:PO BOX 250048
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36125-0048
Mailing Address - Country:US
Mailing Address - Phone:334-286-9919
Mailing Address - Fax:334-286-9621
Practice Address - Street 1:1441 NARROW LANE PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2654
Practice Address - Country:US
Practice Address - Phone:334-286-9919
Practice Address - Fax:334-286-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL44OtherLICENSE
AL000056078Medicaid
AL0163330001OtherMEDICARE NSC
AL0163330001OtherMEDICARE NSC