Provider Demographics
NPI:1154820397
Name:ADVANCED ORTHOPEDIC ALLIANCE
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMBROSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-485-4491
Mailing Address - Street 1:2765 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-8659
Mailing Address - Country:US
Mailing Address - Phone:901-485-4491
Mailing Address - Fax:
Practice Address - Street 1:415 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-6404
Practice Address - Country:US
Practice Address - Phone:901-485-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies