Provider Demographics
NPI:1831497940
Name:ANDERSON PHYSICIAN ALLIANCE, INC
Entity Type:Organization
Organization Name:ANDERSON PHYSICIAN ALLIANCE, INC
Other - Org Name:UROLOGY CLINIC OF MERIDIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RISPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-553-6118
Mailing Address - Street 1:1302 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4120
Mailing Address - Country:US
Mailing Address - Phone:601-693-1055
Mailing Address - Fax:601-482-5312
Practice Address - Street 1:1302 20TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4120
Practice Address - Country:US
Practice Address - Phone:601-693-1055
Practice Address - Fax:601-482-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty