Basic Information
| Provider Information | |||||||||
| NPI: | 1124460480 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPORTSMED ORTHOPAEDIC SPECIALISTS, P.C. | ||||||||
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| OtherOrganizationName: | SPORTSMED ORTHOPAEDIC SURGERY & SPINE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4715 WHITESBURG DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 MAIN AVE SW | ||||||||
| Address2: | SUITE G | ||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350555299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2013 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | JANSSEN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2568815151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 16457 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.