1598414880 NPI number — INTERNAL MEDICINE ASSOCIATES OF TUSCALOOSA, P.C.

Table of content: DR. MICHAEL RAYMOND SANDISON M.D. (NPI 1154316990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598414880 NPI number — INTERNAL MEDICINE ASSOCIATES OF TUSCALOOSA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF TUSCALOOSA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598414880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RICE MINE RD N STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-3905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-349-4200
Provider Business Mailing Address Fax Number:
205-349-4285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RICE MINE RD N STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-349-4200
Provider Business Practice Location Address Fax Number:
205-349-4285
Provider Enumeration Date:
03/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
SYSTEM ADMINISTRATOR
Authorized Official Telephone Number:
205-349-4200

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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