Organization Name: | ANDALUSIA MEDICAL CENTER, LLC |
NPI Number: | 1831479781 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN RAY DIEL (M.D./OWNER) |
Mailing Address: | 1800 Us Hwy 84 West Opp |
State: | AL US |
Postal Code: | 364673520 |
Phone Number: | 3344934357 |
Fax Number: | 3342223825 |
NPI Enumeration Date: | 08/24/2011 |
NPI Last Update Date: | 12/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |