Provider Demographics
NPI:1407522774
Name:ORTHOSPORTS ASSOCIATES
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:W
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-939-0447
Mailing Address - Street 1:833 SAINT VINCENTS DR STE 403
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1614
Mailing Address - Country:US
Mailing Address - Phone:205-939-0447
Mailing Address - Fax:
Practice Address - Street 1:124 S ANNISTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2904
Practice Address - Country:US
Practice Address - Phone:205-838-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOSPORTS ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127553Medicaid