Basic Information
Provider Information | |||||||||
NPI: | 1922245778 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ATHENS LIMESTONE HEALTH SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ATHENS LIMESTONE ORTHOPEDIC CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 999 | ||||||||
Address2: |   | ||||||||
City: | ATHENS | ||||||||
State: | AL | ||||||||
PostalCode: | 356120999 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2562169630 | ||||||||
FaxNumber: | 2562169652 | ||||||||
Practice Location | |||||||||
Address1: | 209 FITNESS WAY | ||||||||
Address2: | SUITE C | ||||||||
City: | ATHENS | ||||||||
State: | AL | ||||||||
PostalCode: | 356112451 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2562169630 | ||||||||
FaxNumber: | 2562169652 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/15/2009 | ||||||||
LastUpdateDate: | 01/15/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COMER | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: | R | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 2562339172 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.