Provider Demographics
NPI:1568041671
Name:ORTHOSPORTS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
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 1:2104 ROCKY RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5138
Practice Address - Country:US
Practice Address - Phone:205-939-0477
Practice Address - Fax:205-939-0418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOSPORTS ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127553Medicaid