Provider Demographics
NPI:1467657957
Name:PALMER ORTHOPAEDIC & SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:PALMER ORTHOPAEDIC & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-997-9777
Mailing Address - Street 1:315 MEDICAL CENTER DR. SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-997-9777
Mailing Address - Fax:256-997-9768
Practice Address - Street 1:315 MEDICAL CENTER DR. SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-997-9777
Practice Address - Fax:256-997-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
AL17684207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932930Medicaid
5977990001OtherMEDICARE DME
DG4090OtherMEDICARE RAILROAD
DG4090OtherMEDICARE RAILROAD
ALDG4090Medicare PIN
AL529932930Medicaid
ALG79443Medicare UPIN