1790246023 NPI number — DR. MADISON SHIRKEY ANDERSON MD

Table of content: DR. MADISON SHIRKEY ANDERSON MD (NPI 1790246023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790246023 NPI number — DR. MADISON SHIRKEY ANDERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
MADISON
Provider Middle Name:
SHIRKEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIRKEY
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
MADISON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790246023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5170 US ROUTE 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25705-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-399-4422
Provider Business Mailing Address Fax Number:
304-399-4433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5170 US ROUTE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-4422
Provider Business Practice Location Address Fax Number:
304-399-4433
Provider Enumeration Date:
03/28/2019

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: 208000000X , with the licence number:  31505 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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