Provider Demographics
NPI:1023220688
Name:INNOVATIVE ORTHOPAEDICS AND SPORTS MEDICINE PC
Entity type:Organization
Organization Name:INNOVATIVE ORTHOPAEDICS AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-764-7781
Mailing Address - Street 1:2201 CLOYD BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1505
Mailing Address - Country:US
Mailing Address - Phone:256-764-7781
Mailing Address - Fax:256-764-3908
Practice Address - Street 1:2201 CLOYD BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1505
Practice Address - Country:US
Practice Address - Phone:256-764-7781
Practice Address - Fax:256-764-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14844207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05155430Medicaid
AL1003909375OtherINDIVIDUAL NPI NUMBER
AL51000113OtherBLUE CROSS BLUE SHIELD
ALP00192214OtherRAIL ROAD MEDICARE
AL05155430Medicare ID - Type Unspecified
AL05155430Medicaid