Provider Demographics
NPI:1417096371
Name:ALABAMA ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:ALABAMA ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:MISSISSIPPI ORTHOTICS & PROSTHETICS,INC.
Other - Org Type:Doing Business As
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:CPLP
Authorized Official - Phone:256-536-5625
Mailing Address - Street 1:2411 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5348
Mailing Address - Country:US
Mailing Address - Phone:662-281-1007
Mailing Address - Fax:662-234-7448
Practice Address - Street 1:2411 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5348
Practice Address - Country:US
Practice Address - Phone:662-281-1007
Practice Address - Fax:662-234-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MS335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0340940006Medicare NSC