Organization
ALABAMA SPORTS MEDICINE AND ORTHO CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. H MICHAEL IMMEL (ADMINISTRATOR)
(205) 939-3000
Entity
Organization
Contact information
Practice address
806 ST VINCENTS DRIVE, SUITE 415, BHAM, AZ 35205
(205) 939-3000
(205) 930-0008
Mailing address
2800 UNIVERSITY BLVD, SUITE 100, BHAM, AZ 35233
(205) 939-3000
(205) 930-0008
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0310040001
CIGNA GOVERNMENT SERVICES
AL
Enumeration date
02/17/2006
Last updated
02/14/2008
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