Provider Demographics
NPI:1508852690
Name:ALABAMA ORTHOTICS & PROSTHETICS,INC
Entity Type:Organization
Organization Name:ALABAMA ORTHOTICS & PROSTHETICS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERY
Authorized Official - Middle Name:O
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CP,LP
Authorized Official - Phone:256-536-5625
Mailing Address - Street 1:1241 MILITARY ST S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-5004
Mailing Address - Country:US
Mailing Address - Phone:205-921-7543
Mailing Address - Fax:205-921-4933
Practice Address - Street 1:1241 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5004
Practice Address - Country:US
Practice Address - Phone:205-921-7543
Practice Address - Fax:205-921-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21325OtherBCBS OF ALABAMA
AL0340940005Medicare ID - Type Unspecified