Basic Information
| Provider Information | |||||||||
| NPI: | 1043397763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ALABAMA BONE & JOINT CLINIC P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 VETERANS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356304930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | 2562463227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1751 VETERANS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | 2562463227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2567183200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 529300660 | 05 | AL | MEDICAID | C10434 | 01 | MEDICARE RR | OTHER |