Organization
DECATUR ORTHOPAEDIC CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA B BUCHANAN (OFFICE MANAGER)
(256) 350-0362
Entity
Organization
Contact information
Practice address
1107 14TH AVE SE STE 300, DECATUR, AL 35601-3368
(256) 350-0362
(256) 355-9779
Mailing address
1107 14TH AVE SE STE 300, DECATUR, AL 35601-3368
(256) 350-0362
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009932533
ALABAMA MEDICAID DME
AL
05
—
528600740
—
AL
01
—
CH5919
MEDICARE RAILROAD
AL
Enumeration date
01/12/2007
Last updated
02/09/2024
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