Provider Demographics
NPI:1912305988
Name:ANDERSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ANDERSON REGIONAL MEDICAL CENTER
Other - Org Name:ANDERSON FAMILY MEDICAL CLINIC ALDERSGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-5010
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:601-703-3480
Mailing Address - Fax:601-703-0124
Practice Address - Street 1:6694 POPLAR SPRINGS DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305
Practice Address - Country:US
Practice Address - Phone:601-703-8425
Practice Address - Fax:601-703-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty