1982763165 NPI number — KEITH C. ANDERSON, D.O.

Table of content: (NPI 1982763165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982763165 NPI number — KEITH C. ANDERSON, D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH C. ANDERSON, D.O.
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:
1982763165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35815-4799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-4545
Provider Business Mailing Address Fax Number:
256-539-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 GOVERNORS DRIVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-4545
Provider Business Practice Location Address Fax Number:
256-539-4990
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
256-539-4545

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  DO-250 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180012766 . This is a "MEDICARE, RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 8045502 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83822 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com