1912902024 NPI number — CC ANDERSON PC

Table of content: (NPI 1912902024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912902024 NPI number — CC ANDERSON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CC ANDERSON PC
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:
MEDICAP
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:
1912902024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 ANNEX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADRID
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50156-1471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 ANNEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADRID
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50156-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-795-4252
Provider Business Practice Location Address Fax Number:
515-795-4255
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
515-795-4252

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  274 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0298539 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21514 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005817300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025316200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20056411500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8530970 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1621627 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370458100 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200321290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com