SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE AND SPINE CENTER, PC (NPI# 1780281741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780281741 |
| Entity Type | Organization |
| Organization Name | SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE AND SPINE CENTER, PC |
| Practice Address |
4524 Southlake Pkwy Ste 26 Hoover AL 35244-3272 |
| Mailing Address |
4517 Southlake Pkwy Hoover AL 35244-3280 |
| Practice Telephone | 2053297566 |
| Practice Fax Number | 8884359974 |
| Mailing Telephone | 2059854111 |
| Mailing Fax Number | 2059854326 |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | MICHAEL FRANCES BLUM (PRESIDENT) |
| Authorized Official Telephone | 2059854111 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE AND SPINE CENTER, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| Other Name | Type Code |
|---|---|
| Southlake Prosthetics and Orthotics | Doing Business As Name - Organization |
| Street Address |
4524 SOUTHLAKE PKWY STE 26 |
| City | HOOVER |
| State | AL |
| Zip Code | 35244-3272 |
| 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 | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295700847 | Benchmark Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 3141 Lorna Rd, Suite 100, Hoover, AL 35216-5416 | 2006-02-17 |
| 1720314941 | Anita's Wigs, LLC | Prosthetic/Orthotic Supplier | 180 Main St, Suite 128, Hoover, AL 35244-5064 | 2009-10-22 |
| 1427222470 | Pedorthic Care, LLC | Prosthetic/Orthotic Supplier | 3141 Lorna Rd, Suite 100, Hoover, AL 35216-5416 | 2008-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912532367 | Gina Denise Tedford | Prosthetic/Orthotic Supplier | 2301 Highway 31 Nw, Hartselle, AL 35640-4258 | 2020-03-05 |
| 1740794734 | Alabama Artificial Limb & Orthopedic Service, Inc. | Prosthetic/Orthotic Supplier | 721 Oak Circle Dr E Ste B, Mobile, AL 36609-4221 | 2017-11-29 |
| 1922545243 | Windblown Wigs N Thangs | Prosthetic/Orthotic Supplier | 1292 Forestdale Sq, Forestdale, AL 35214-3838 | 2017-01-24 |
| 1386186674 | A Step Ahead Orthotics and Prosthetics Inc | Prosthetic/Orthotic Supplier | 1140 Eagletree Ln Sw Ste 102, Huntsville, AL 35801-7429 | 2016-11-17 |
| 1538619424 | A Step Ahead, LLC | Prosthetic/Orthotic Supplier | 7123 Halcyon Park Dr, Suite A, Montgomery, AL 36117-7702 | 2016-10-04 |
| 1679029698 | Salon Wygs | Prosthetic/Orthotic Supplier | 2236 Cahaba Valley Dr, Birmingham, AL 35242-2671 | 2016-08-30 |
| 1891176517 | Hal Medical O&p, PC | Prosthetic/Orthotic Supplier | 22923 Us Highway 72 Ste A, Athens, AL 35613-7618 | 2015-06-18 |
| 1083093124 | Rhonda Reed | Prosthetic/Orthotic Supplier | 2227 Arlington Ave S, Birmingham, AL 35205-4003 | 2015-05-21 |
| 1285020008 | Restorative Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 28080 Us Highway 98 Ste G, Daphne, AL 36526-7012 | 2015-04-08 |
| 1790179489 | Vamousse/your Salon Refuge | Prosthetic/Orthotic Supplier | 703 3rd Ave N, Birmingham, AL 35203-3023 | 2015-03-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE AND 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.