Provider Demographics
NPI:1558772012
Name:TUSCALOOSA PROSTHETICS & ORTHOTICS
Entity Type:Organization
Organization Name:TUSCALOOSA PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-215-8543
Mailing Address - Street 1:5184 CALDWELL MILL RD
Mailing Address - Street 2:SUITE 204-183
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1912
Mailing Address - Country:US
Mailing Address - Phone:205-215-8543
Mailing Address - Fax:
Practice Address - Street 1:100 TOWNCENTER BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1833
Practice Address - Country:US
Practice Address - Phone:205-901-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier