1457574527 NPI number — MR. PERRY J ANDERSON JR. MSW

Table of content: MR. PERRY J ANDERSON JR. MSW (NPI 1457574527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457574527 NPI number — MR. PERRY J ANDERSON JR. MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
PERRY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSW
Provider Gender Code:
M

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:
1457574527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 105TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54001-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-268-5165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 POLK COUNTY PLZ
Provider Second Line Business Practice Location Address:
SUITE 50
Provider Business Practice Location Address City Name:
BALSAM LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54810-9071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-485-8445
Provider Business Practice Location Address Fax Number:
715-485-8490
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6798-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40930200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1258073 . This is a "ARAZ INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2068111 . This is a "CIGNA INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 338871 . This is a "TRI CARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: P 12027501 . This is a "WPPN INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 84 81085 . This is a "MEDICA INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 373595 . This is a "MHN HMC INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 37F39PE . This is a "BCBS MN INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1026794 . This is a "PREFERRED ONE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com