Organization
SOUTHLAKE ORTHOPAEDICS DBA SOUTHLAKE PROSTHETICS & ORTHOTICS
Active
Parent organization
SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC
Other names
Southlake Orthopaedics dba Southlake Prosthetics & Orthotics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC
Authorized official
MR. ROBERT CRABTREE (ADMINISTRATOR)
(205) 985-4111
Entity
Organization
Contact information
Practice address
4524 SOUTHLAKE PKWY STE 26, HOOVER, AL 35244-3272
(205) 985-4111
(205) 267-4411
Mailing address
4517 SOUTHLAKE PKWY, HOOVER, AL 35244-3280
(205) 985-4111
(205) 267-4411
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124555
—
AL
Enumeration date
04/14/2021
Last updated
02/10/2022
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