Provider Demographics
NPI:1528084787
Name:ORTHOPAEDIC AND SPORTS MEDICINE OF MOBILE, PC
Entity type:Organization
Organization Name:ORTHOPAEDIC AND SPORTS MEDICINE OF MOBILE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-631-3004
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:D146
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-639-7283
Mailing Address - Fax:251-639-7460
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:D146
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-639-7283
Practice Address - Fax:251-639-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13229207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1265410658OtherNPI
AL1083692479OtherNPI
ALC16415Medicare UPIN
AL1083692479OtherNPI