Provider Demographics
NPI:1831133586
Name:ORTHOPAEDIC SPECIALISTS OF ALABAMA PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF ALABAMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3090
Mailing Address - Street 1:48 MEDICAL PARK EAST DR
Mailing Address - Street 2:STE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-838-6783
Practice Address - Street 1:48 MEDICAL PARK EAST DR
Practice Address - Street 2:STE 255
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3090
Practice Address - Fax:205-838-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528201850Medicaid
AL528201850Medicaid
AL0333120001Medicare NSC