Provider Demographics
NPI:1760420384
Name:WEST ALABAMA ORTHOPAEDIC AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:WEST ALABAMA ORTHOPAEDIC AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:BANKS
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-330-4206
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-0840
Mailing Address - Country:US
Mailing Address - Phone:205-333-8800
Mailing Address - Fax:205-333-8406
Practice Address - Street 1:1325 MCFARLAND BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3270
Practice Address - Country:US
Practice Address - Phone:205-333-8800
Practice Address - Fax:205-333-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009008207X00000X
AL00022472207X00000X
ALDO932208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923320Medicaid
DD2144Medicare PIN
ALK412Medicare ID - Type UnspecifiedGROUP MEDICARE #
AL529923320Medicaid