Provider Demographics
NPI:1437202009
Name:ANDALUSIA PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:ANDALUSIA PHYSICIAN PRACTICES LLC
Other - Org Name:ANDALUSIA NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1200
Mailing Address - Country:US
Mailing Address - Phone:334-222-2332
Mailing Address - Fax:334-222-2475
Practice Address - Street 1:109 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5323
Practice Address - Country:US
Practice Address - Phone:334-222-2332
Practice Address - Fax:334-222-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL277422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALL146Medicare PIN