Provider Demographics
NPI:1356347926
Name:ABC ORTHOTICS & PROSTHETICS, INC
Entity type:Organization
Organization Name:ABC ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:205-324-2461
Mailing Address - Street 1:3616 7TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3217
Mailing Address - Country:US
Mailing Address - Phone:205-324-2461
Mailing Address - Fax:205-324-7271
Practice Address - Street 1:3616 7TH CT S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-3217
Practice Address - Country:US
Practice Address - Phone:205-324-2461
Practice Address - Fax:205-324-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL05010916335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52115OtherBCBS-AL
AL0546080001Medicare ID - Type Unspecified