Provider Demographics
NPI:1851665095
Name:ORTHOSPORTS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORTHOSPORTS ASSOCIATES LLC
Other - Org Name:ORTHOSPORTS ASSOCIATES LLC - CHELSEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-838-3090
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:BUILDING 3, SUITE 403
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-939-0447
Mailing Address - Fax:
Practice Address - Street 1:16233 HIGHWAY 280
Practice Address - Street 2:SUITE G
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8355
Practice Address - Country:US
Practice Address - Phone:205-838-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty