Provider Demographics
NPI:1750671665
Name:ANDERSON PHYSICIAN ALLIANCE, INC.
Entity Type:Organization
Organization Name:ANDERSON PHYSICIAN ALLIANCE, INC.
Other - Org Name:ANDERSON FAMILY MEDICAL CENTER - ENTERPRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-553-6104
Mailing Address - Street 1:2124 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4040
Mailing Address - Country:US
Mailing Address - Phone:601-553-6104
Mailing Address - Fax:601-553-6144
Practice Address - Street 1:83 OLD MILL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:MS
Practice Address - Zip Code:39330-9649
Practice Address - Country:US
Practice Address - Phone:601-703-3465
Practice Address - Fax:601-703-3408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON PHYSICIAN ALLIANCE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty