Provider Demographics
NPI:1922272624
Name:EAST ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:EAST ALABAMA ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-528-3008
Mailing Address - Street 1:2000 PEPPERELL PKWY
Mailing Address - Street 2:BLD. 5
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5452
Mailing Address - Country:US
Mailing Address - Phone:334-528-2663
Mailing Address - Fax:334-528-2669
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:BLD. 5
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-2663
Practice Address - Fax:334-528-2669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ALABAMA MEDICAL DEVELOPMENT ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty