Provider Demographics
NPI:1972780757
Name:LEMAK SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:LEMAK SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEMAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-329-7501
Mailing Address - Street 1:1286 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6929
Mailing Address - Country:US
Mailing Address - Phone:205-329-7501
Mailing Address - Fax:205-329-7536
Practice Address - Street 1:831 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8944
Practice Address - Country:US
Practice Address - Phone:205-358-9120
Practice Address - Fax:205-358-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
AL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
510G700127Medicare PIN