1710352356 NPI number — ANDERSON REGIONAL MEDICAL CENTER

Table of content: (NPI 1710352356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710352356 NPI number — ANDERSON REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON REGIONAL MEDICAL CENTER
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:
ANDERSON EXPRESS CARE CLINIC
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:
1710352356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2124 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-4040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-703-3480
Provider Business Mailing Address Fax Number:
601-703-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1523 22ND AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-703-8450
Provider Business Practice Location Address Fax Number:
601-703-8459
Provider Enumeration Date:
12/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-703-5010

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03651367 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209283 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 555935 . This is a "MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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