NPIMap

Organization Active NPI

Dothan Brace Shop

  • Durable Medical Equipment & Medical Supplies
  • Dothan, AL
National Provider Identifier
1730189028
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
172 Issued in AL
Legal business name
DOTHAN BRACE SHOP
Practice address
1240 E Main St
Dothan, AL 36301-1732
Phone
(334) 792-4330
Fax
(334) 794-6741
NPI assigned
Jul 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Authorized official

Name
Mr. Willis H Smitherman, CPO
Title
President
Phone
(334) 792-4330

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 172 AL Primary
Prosthetic/Orthotic Supplier 335E00000X 001 AL

Addresses

Primary practice location

1240 E Main St
Dothan, AL 36301-1732

Mailing address

1240 E Main St
Dothan, AL 36301-1732
Phone (334) 792-4330

Other identifiers 4

IdentifierTypeStateIssuer
000040862BOtherGAMEDICAID
000040862AMedicaidGA
000050220MedicaidAL
51050220OtherBCBS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1730189028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 E MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363011732",
            "telephone_number": "334-792-4330",
            "fax_number": "334-794-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 E MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363011732",
            "telephone_number": "334-792-4330",
            "fax_number": "334-794-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN BRACE SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "SMITHERMAN",
        "authorized_official_first_name": "WILLIS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-792-4330",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "172",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AL",
            "license": "001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "000040862B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000040862A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000050220",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51050220",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.