Provider Demographics
NPI:1063553741
Name:SPORTSMED ORTHOPAEDIC SPECIALISTS, P.C.
Entity type:Organization
Organization Name:SPORTSMED ORTHOPAEDIC SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-650-1242
Mailing Address - Street 1:2506 DANVILLE RD SW STE 202
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4232
Mailing Address - Country:US
Mailing Address - Phone:256-306-0800
Mailing Address - Fax:256-309-0943
Practice Address - Street 1:2506 DANVILLE RD SW STE 202
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4232
Practice Address - Country:US
Practice Address - Phone:256-306-0800
Practice Address - Fax:256-309-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4694770005Medicare NSC