Healthcare Provider Details

I. General information

NPI: 1811295496
Provider Name (Legal Business Name): ANDERSON PHYSICIAN ALLIANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E PUSHMATAHA ST
BUTLER AL
36904-2628
US

IV. Provider business mailing address

522 E PUSHMATAHA ST
BUTLER AL
36904-2628
US

V. Phone/Fax

Practice location:
  • Phone: 205-459-4400
  • Fax: 205-459-6886
Mailing address:
  • Phone: 205-459-4400
  • Fax: 205-459-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY RISPOLI
Title or Position: CFO
Credential:
Phone: 601-553-6118