Provider Demographics
NPI:1366636706
Name:ANNISTON ORTHOPEDICS ASSOCIATES PA
Entity Type:Organization
Organization Name:ANNISTON ORTHOPEDICS ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:256-236-4121
Mailing Address - Street 1:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1765
Mailing Address - Country:US
Mailing Address - Phone:256-236-4121
Mailing Address - Fax:256-237-5254
Practice Address - Street 1:731 LEIGHTON AVE STE 405
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5766
Practice Address - Country:US
Practice Address - Phone:256-236-4121
Practice Address - Fax:256-237-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCO41Medicare PIN