=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811295496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDERSON PHYSICIAN ALLIANCE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2011
-----------------------------------------------------
Last Update Date | 03/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 E PUSHMATAHA ST
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36904-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-459-4400
-----------------------------------------------------
Fax | 205-459-6886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 E PUSHMATAHA ST
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36904-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-459-4400
-----------------------------------------------------
Fax | 205-459-6886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. ANTHONY RISPOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-553-6118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------