1891752176 NPI number — DR. JOHN A ANSON M.D.

Table of content: DR. JOHN A ANSON M.D. (NPI 1891752176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891752176 NPI number — DR. JOHN A ANSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANSON
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1891752176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-948-8897
Provider Business Mailing Address Fax Number:
702-549-3178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8530 W SUNSET RD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-851-0792
Provider Business Practice Location Address Fax Number:
702-851-0797
Provider Enumeration Date:
04/28/2006

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: 207T00000X , with the licence number:  8076 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: 27062 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 357661-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 140006092 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1891752176 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00089608 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 133710 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DL024Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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