1053407635 NPI number — MR. CHRISTIAN ANDERSON CPC

Table of content: MR. CHRISTIAN ANDERSON CPC (NPI 1053407635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053407635 NPI number — MR. CHRISTIAN ANDERSON CPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CHRISTIAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPC
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:
1053407635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 LAKEPORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING CREEK
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89815-6048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-299-9906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-779-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006

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: 101YP2500X , with the licence number:  20065 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CP0001 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 743025435 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NM600035 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 100516741 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84839L . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1784936-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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