Healthcare Provider Details

I. General information

NPI: 1720008063
Provider Name (Legal Business Name): JAMES DEVANE ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W COVINGTON AVE B
OPP AL
36467-2032
US

IV. Provider business mailing address

PO BOX 375
OPP AL
36467-0375
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-7081
  • Fax: 334-493-1525
Mailing address:
  • Phone: 334-493-7081
  • Fax: 334-493-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES DEVANE ANDERSON
Title or Position: OWNER
Credential: RRT
Phone: 334-493-7081