Provider Demographics
NPI:1982763165
Name:KEITH C. ANDERSON, D.O.
Entity Type:Organization
Organization Name:KEITH C. ANDERSON, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-539-4545
Mailing Address - Street 1:PO BOX 4799
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35815-4799
Mailing Address - Country:US
Mailing Address - Phone:256-539-4545
Mailing Address - Fax:256-539-4990
Practice Address - Street 1:201 GOVERNORS DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5123
Practice Address - Country:US
Practice Address - Phone:256-539-4545
Practice Address - Fax:256-539-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-250208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL180012766OtherMEDICARE, RAILROAD
8045502OtherCIGNA
AL83822OtherBLUE CROSS OF ALABAMA
8045502OtherCIGNA