Provider Demographics
NPI:1619013422
Name:SHOALS ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:SHOALS ORTHOPEDICS, PC
Other - Org Name:SHOALS ORTHOPEDICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-718-4041
Mailing Address - Street 1:426 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:426 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5521
Practice Address - Country:US
Practice Address - Phone:256-718-4041
Practice Address - Fax:256-718-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4562760001OtherMEDICARE DMERC
AL529911910Medicaid
AL529911910Medicaid