Provider Demographics
NPI:1639520026
Name:REGAL ORTHOTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:REGAL ORTHOTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-594-1799
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0396
Mailing Address - Country:US
Mailing Address - Phone:256-594-1799
Mailing Address - Fax:256-594-1797
Practice Address - Street 1:1108 S BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2514
Practice Address - Country:US
Practice Address - Phone:256-594-1799
Practice Address - Fax:256-594-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1674332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7574160001Medicare NSC