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General NPI Number Information
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NPI Number | 1154554616
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY ASSOCIATES OF WYTHEVILLE
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 360 VIRGINIA AVE
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1185
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Country | US
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Telephone | 276-228-5506
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Fax | 276-228-9600
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Provider Business Mailing Address
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Address Line | 175 W MONROE ST BOX 266
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City | WYTHEVILLE
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State | VA
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Zip | 24382-2341
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Country | US
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Telephone | 276-228-5506
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Fax | 276-228-9600
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Authorized Official
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Title or Position | CEO/OWNER/COL (R)
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Name | DR. DONALD R ANDERSON
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Credential | MD, FACC, FCCP
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Telephone | 276-228-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101246201
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License Number State | VA
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