Provider Demographics
NPI:1972518736
Name:ADVANCED ORTHOPEDIC SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC SURGICAL SPECIALISTS
Other - Org Name:DR. WARNER L. PINCHBACK
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PINCHBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-262-0523
Mailing Address - Street 1:1329 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1132
Mailing Address - Country:US
Mailing Address - Phone:334-262-0523
Mailing Address - Fax:334-262-5915
Practice Address - Street 1:1329 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1132
Practice Address - Country:US
Practice Address - Phone:334-262-0523
Practice Address - Fax:334-262-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8817261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528800430Medicaid
AL1140280001Medicare NSC
AL528800430Medicaid