Provider Demographics
NPI:1689969156
Name:ALABAMA SPINE & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ALABAMA SPINE & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-822-8320
Mailing Address - Street 1:2017 CANYON RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1900
Mailing Address - Country:US
Mailing Address - Phone:205-822-8320
Mailing Address - Fax:205-822-8323
Practice Address - Street 1:2017 CANYON RD
Practice Address - Street 2:SUITE 21
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1900
Practice Address - Country:US
Practice Address - Phone:205-822-8320
Practice Address - Fax:205-822-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DR9703OtherRR MEDICARE
AL102G705593Medicare PIN