1457405920 NPI number — ANDERSON MEDICAL ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457405920 NPI number — ANDERSON MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON MEDICAL ASSOCIATES
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:
NIRMAL S MEHTON
Provider Other Organization Name Type Code:
3
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:
1457405920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/11/2008
NPI Reactivation Date:
11/10/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96007-0667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-365-2545
Provider Business Mailing Address Fax Number:
530-365-7349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2830 EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96007-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-365-2545
Provider Business Practice Location Address Fax Number:
530-365-7349
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEHTON
Authorized Official First Name:
NIRMAL
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
MD OWNER
Authorized Official Telephone Number:
530-365-2545

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RHM53832H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0092270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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