Provider Demographics
NPI:1831479781
Name:ANDALUSIA MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ANDALUSIA MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-493-4357
Mailing Address - Street 1:1800 US HWY 84 WEST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-3520
Mailing Address - Country:US
Mailing Address - Phone:334-493-4357
Mailing Address - Fax:334-222-3825
Practice Address - Street 1:1800 US HWY 84 WEST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-3520
Practice Address - Country:US
Practice Address - Phone:334-493-4357
Practice Address - Fax:334-222-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty