Provider Demographics
NPI:1316933617
Name:ALABAMA ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:ALABAMA ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
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 1:1501 CLIFF GOOKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6401
Mailing Address - Country:US
Mailing Address - Phone:662-396-4670
Mailing Address - Fax:662-396-4677
Practice Address - Street 1:3205 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9398
Practice Address - Country:US
Practice Address - Phone:662-396-4670
Practice Address - Fax:662-396-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3160016OtherBCBS OF TENNESSEE
MS00440966Medicaid
MS20423OtherTLC
MS00440966Medicaid