Organization
SHOALS ORTHOTICS & PROSTHETICS,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN A BLACKWELL C.P.O,L.PO (PRESIDENT)
(256) 764-8673
Entity
Organization
Contact information
Practice address
840 FLORENCE BLVD, FLORENCE, AL 35630-4871
(256) 764-8673
(256) 764-0872
Mailing address
840 FLORENCE BLVD, FLORENCE, AL 35630-4871
(256) 764-8673
(256) 764-0872
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
78997
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000054615
—
AL
01
—
0071305
BCBS OF TENNESSEE
AL
01
—
51054615
BCBS OF ALABAMA
AL
Enumeration date
09/22/2005
Last updated
01/29/2025
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