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Organization
UNIVERSITY ORTHOPAEDIC CLINIC, PC
Active
Organization
UNIVERSITY ORTHOPAEDIC CLINIC, PC
Active
Parent organization
UNIVERSITY ORTHOPAEDIC CLINIC, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY ORTHOPAEDIC CLINIC, PC
Authorized official
MRS. DONNA S WOOD (CHIEF EXECUTIVE OFFICER)
(205) 345-0192
Entity
Organization
Contact information
Practice address
1732 TEMPLE AVE N, FAYETTE, AL 35555-1321
(205) 345-0192
(205) 247-2194
Mailing address
PO BOX 2447, TUSCALOOSA, AL 35403-2447
(205) 345-0192
(205) 247-2194
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51036272
BLUE CROSS BLUE SHIELD
AL
05
—
528301220
—
AL
Enumeration date
12/14/2010
Last updated
12/14/2010
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