Provider Demographics
NPI:1376539874
Name:ALABAMA ORTHOTICS & PROSTHETICS,INC.
Entity Type:Organization
Organization Name:ALABAMA ORTHOTICS & PROSTHETICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:256-536-5625
Mailing Address - Street 1:2100 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4540
Mailing Address - Country:US
Mailing Address - Phone:256-536-5625
Mailing Address - Fax:256-536-5697
Practice Address - Street 1:2100 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4540
Practice Address - Country:US
Practice Address - Phone:256-536-5625
Practice Address - Fax:256-536-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AL093894335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0016488OtherBCBS OF TENNESSEE
AL072105174OtherDUNS AND BRADSTREET
AL000054339Medicaid
AL510-54339OtherBCBS OF ALABAMA
AL510-54339OtherBCBS OF ALABAMA