1194838128 NPI number — SCOTT G ANDERS MD

Table of content: SCOTT G ANDERS MD (NPI 1194838128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194838128 NPI number — SCOTT G ANDERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERS
Provider First Name:
SCOTT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194838128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6985 UNION PARK CTR
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
COTTONWOOD HEIGHTS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84047-4177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-568-5948
Provider Business Mailing Address Fax Number:
801-571-1369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6985 UNION PARK CTR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
COTTONWOOD HEIGHTS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84047-4177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-568-5948
Provider Business Practice Location Address Fax Number:
801-571-1369
Provider Enumeration Date:
08/16/2006

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: 207Q00000X , with the licence number:  6999225-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194838128 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6999225120001 . This is a "REGENCE BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: T72276 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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