Southlake Orthopaedics Dba Southlake Prosthetics & Orthotics

Primary specialty

ProsthetistTaxonomy code 224P00000X

Legal business name

SOUTHLAKE ORTHOPAEDICS DBA SOUTHLAKE PROSTHETICS & ORTHOTICS

Practice address

4524 Southlake Pkwy Ste 26
Hoover, AL 35244-3272

Phone

(205) 985-4111

Fax

(205) 267-4411

NPI assigned

Apr 14, 2021

Organization subpart

Yes

Parent organization

SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Crabtree

Title

Administrator

Phone

(205) 985-4111

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Southlake Orthopaedics dba Southlake Prosthetics & Orthotics Doing business as

Tax ID family

Charlie J Talbert MD2 organizations share this tax ID, including this one

Part of

Charlie J Talbert MD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southlake Orthopaedics Sports Medicine and Spine Center, PC

  • Orthopaedic Hand Surgery Physician
  • Hoover, AL
  • NPI 1639746050
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1508447343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 SOUTHLAKE PKWY",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443280",
            "telephone_number": "205-985-4111",
            "fax_number": "205-267-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4524 SOUTHLAKE PKWY STE 26",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443272",
            "telephone_number": "205-985-4111",
            "fax_number": "205-267-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE ORTHOPAEDICS DBA SOUTHLAKE PROSTHETICS & ORTHOTICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC",
        "enumeration_date": "2021-04-14",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "CRABTREE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "205-985-4111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prosthetist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124555",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southlake Orthopaedics dba Southlake Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southlake Orthopaedics dba Southlake Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern Orthopaedic Alliance, PLLC
• Southern Perioperative Services P C
• Southern Smiles
• Elizabeth M. Southern
• Southlake Dental Care Management
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Victoria Louise Spain, PHARMD
• Spaulding Enterprises LLC

• Prosthetist in Hoover, AL
• Providers in Hoover, AL by specialty
• Prosthetist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.