SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC (NPI# 1043268402) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043268402 |
| Entity Type | Organization |
| Organization Name | SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC |
| Other Organization Name | SOUTHLAKE ORTHOPAEDICS |
| Practice Address |
4517 Southlake Pkwy Birmingham AL 35244-3280 |
| Mailing Address |
4517 Southlake Pkwy Hoover AL 35244-3280 |
| Practice Telephone | 2059854111 |
| Practice Fax Number | 2059854326 |
| Mailing Telephone | 2059854111 |
| Mailing Fax Number | 2059854326 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-06-18 |
| Authorized Official Name | MR. ROBERT CRABTREE (ADMINISTRATOR) |
| Authorized Official Telephone | 2059854111 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 9307 | AL | Other Service Providers |
| N | 207XS0106X |
Orthopaedic Surgery Specialization: Hand Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
Allopathic & Osteopathic Physicians | ||
| N | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 224L00000X | Pedorthist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225000000X | Orthotic Fitter | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 2471M1202X |
Radiologic Technologist Specialization: Magnetic Resonance Imaging |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 529802230 | 05 | |
| AL | MEDICARE | G715 | 01 |
| Other Name | Type Code |
|---|---|
| BRYANT AND BLUM ORTHOPAEDICS | Former Legal Business Name - Organization |
| Southlake Orthopaedics | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4524 Southlake Pkwy Ste 26, Hoover, AL 352443272 | 2053297566 | 8884359974 |
| 3686 Grandview Pkwy Ste 430, Birmingham, AL 352433404 | 2056058180 | 2059728785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497371405 | Southlake Orthopaedics Sports Medicine & Spine Center PC | Internal Medicine | 3686 Grandview Pkwy Ste 430, Birmingham, AL 35243-3404 | 2020-06-25 |
| 1356704654 | Southlake Orthopaedics Sports Medicine & Spine Center PC | Physical Therapist | 4517 Southlake Pkwy, Hoover, AL 35244-3280 | 2016-04-04 |
| Street Address |
4517 SOUTHLAKE PKWY |
| City | BIRMINGHAM |
| State | AL |
| Zip Code | 35244-3280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700154184 | Select Physical Therapy Holdings Inc | Clinic/Center | 4517 Southlake Pkwy, Birmingham, AL 35244-3280 | 2011-12-13 |
| 1760692834 | George Robert Booker | Orthopaedic Surgery | 4517 Southlake Pkwy, Birmingham, AL 35244-3280 | 2007-05-23 |
| 1457453052 | Andrea Moore Jost | Physician Assistant | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-09-02 |
| 1245340108 | Jason P Greer | Physical Therapist | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-08-30 |
| 1902840655 | Leslie M Youngblood | Occupational Therapist | 4517 Southlake Pkwy, Birmingham, AL 35244-3280 | 2006-06-15 |
| 1780639492 | William Krauss | Specialist | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-05-23 |
| 1821047259 | William S Craig Iv | Physical Medicine & Rehabilitation | 4517 Southlake Pkwy, Birmingham, AL 35244-3280 | 2006-05-10 |
| 1518915016 | Michael Frances Blum | Specialist | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-05-05 |
| 1629026158 | Charlie Joe Talbert I | Specialist | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-05-05 |
| 1437107984 | Michael T Ellerbusch | Specialist | 4517 Southlake Pkwy, Suite 202, Birmingham, AL 35244-3280 | 2006-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720691991 | Husam Jebril | Pharmacist | 5445 Park Side Road, Hoover, AL 35244 | 2020-08-27 |
| 1588272546 | Tyana Thomas | Behavior Technician | 1820 Southpark Dr, Hoover, Al 35244, Hoover, AL 35244 | 2020-07-16 |
| 1912520115 | Magic City Physical Therapy | Home Health | 1217 Willow Leaf Circle, Birmingham, AL 35244 | 2020-05-21 |
| 1851941660 | Carehere LLC | Family Medicine | Carehere Clinic- Mercedes Hoover, 130 Riverchase Parkway East, Hoover, AL 35244 | 2019-09-13 |
| 1033690888 | Danielle Waldrep Rich | Speech-Language Pathologist | 605 Russet Lake Drive, Hoover, AL 35244 | 2018-08-28 |
| 1699253559 | Lauren M Martinez | Social Worker | 2524 Valleydale Rd. Suite 100, Birmingham, AL 35244 | 2018-08-02 |
| 1982110284 | Regenerative Medical Institute for Pain & Neuropathy, LLC | Plastic Surgery | 1849 Data Dr Ste 1, Hoover, AL 35244 | 2017-12-21 |
| 1891217014 | Kristen Michelle Woods | Counselor | 3825 Lorna Rd Ste 240, Birmingham, AL 35244 | 2017-07-10 |
| 1255868170 | Home Sweet Home Senior Care | Home Health | 1 Chase Corporate Drive, Suite 400, Birmingham, AL 35244 | 2017-05-23 |
| 1801347455 | Megan Sarah St John | Nurse Practitioner | 2321 Alabama Highway 150, Birmingham, AL 35244 | 2016-10-19 |
| Find all providers in zip 35244 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710520192 | Orthosports Associates, LLC | Orthopaedic Surgery | 7191 Cahaba Valley Rd Ste 200b, Birmingham, AL 35242-6443 | 2019-10-18 |
| 1639576887 | Jason D. Cobb, Md, LLC | Orthopaedic Surgery | 52 Medical Park Dr E Ste 220, Birmingham, AL 35235-3428 | 2014-12-02 |
| 1649614330 | Furnie Wesley Johnston | Orthopaedic Surgery | 3328 East Briarcliff, Birmingham, AL 35223 | 2013-04-24 |
| 1013227222 | Orthopaedic Specialists of Alabama, PC | Orthopaedic Surgery | 720 Montclair Rd., Ste. 200, Birmingham, AL 35213-1964 | 2010-10-21 |
| 1336459528 | Orthopaedic Specialists of Alabama, PC | Orthopaedic Surgery | 801 Princeton Dr., Ste. 710, Birmingham, AL 35211-1309 | 2010-10-21 |
| 1285944405 | Orthopaedic Specialists of Alabama, PC | Orthopaedic Surgery | 833 St. Vincent's Dr., Ste. 403, Birmingham, AL 35205-1614 | 2010-10-21 |
| 1518161504 | Rebecca Anne Moul | Orthopaedic Surgery | 4600 Highway 280 Ste 200, Birmingham, AL 35242-5186 | 2007-06-13 |
| 1457560245 | Ashley Reed Estes | Orthopaedic Surgery | 833 St. Vincent's Drive, Building 3, Suite 403, Birmingham, AL 35205-1614 | 2007-05-21 |
| 1275748428 | Michael David Johnson | Orthopaedic Surgery | 1313 13th St S, Suite 211, Birmingham, AL 35205-5327 | 2007-05-11 |
| 1568516151 | Southern Orthopaedic Specialists, P.C. | Orthopaedic Surgery | 516 Brookwood Blvd, Floor 2, Birmingham, AL 35209-6802 | 2007-01-22 |
| Find all providers in BIRMINGHAM | ||||
| City | BIRMINGHAM |
| Zip Code | 35244 |
Please comment or provide details below to improve the information on SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.