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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