Provider Demographics
NPI:1912044512
Name:ALABAMA ORTHOPEDIC CARE PC
Entity Type:Organization
Organization Name:ALABAMA ORTHOPEDIC CARE PC
Other - Org Name:DARRELL J POTTER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-566-8881
Mailing Address - Street 1:1018 S BRUNDIDGE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3121
Mailing Address - Country:US
Mailing Address - Phone:334-566-8881
Mailing Address - Fax:334-566-7785
Practice Address - Street 1:1018 S BRUNDIDGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3121
Practice Address - Country:US
Practice Address - Phone:334-566-8881
Practice Address - Fax:334-566-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPOO203874OtherMEDICARE RAILROAD
ALPO000041005Medicaid
ALB43962Medicare UPIN
ALPO000041005Medicaid