Basic Information
| Provider Information | |||||||||
| NPI: | 1972780757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEMAK SPORTS MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1286 OAK GROVE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053297501 | ||||||||
| FaxNumber: | 2053297536 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 1ST ST N | ||||||||
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| City: | ALABASTER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350078944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053589120 | ||||||||
| FaxNumber: | 2053589121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | LEMAK | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2053297501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | AL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.