Provider Demographics
NPI:1417229196
Name:ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Entity Type:Organization
Organization Name:ALABAMA ARTIFICIAL LIMB & ORTHOPEDIC SERVICE, INC.
Other - Org Name:ALABAMA ARTIFICIAL LIMB AND ORTHOPEDIC SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATOHVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-8760
Mailing Address - Street 1:102 WOODMONT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5249
Mailing Address - Country:US
Mailing Address - Phone:615-550-8774
Mailing Address - Fax:
Practice Address - Street 1:720 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4622
Practice Address - Country:US
Practice Address - Phone:334-875-9790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL019335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050003Medicaid
AL0082-0000002OtherUNITED HEALTHCARE
AL510-50003OtherBLUE CROSS/BLUE SHIELD OF AL
AL0082-0000002OtherUNITED HEALTHCARE
AL0159380003Medicare NSC
AL0159380001Medicare NSC