1255423695 NPI number — DR. CONRAD ASHTON ANDERSON L.C.S.W., PH.D.

Table of content: HANNAH LIN PA-C (NPI 1306661798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255423695 NPI number — DR. CONRAD ASHTON ANDERSON L.C.S.W., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CONRAD
Provider Middle Name:
ASHTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W., PH.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:
1255423695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
739 BUDDELIA CV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39532-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-365-3552
Provider Business Mailing Address Fax Number:
228-392-9743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1636 POPPS FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39532-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-365-3552
Provider Business Practice Location Address Fax Number:
228-392-9743
Provider Enumeration Date:
09/29/2006

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: 1041C0700X , with the licence number:  L.C.S.W. C#3822 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 302I803223 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 030389866 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06656046 . This is a "MS MEDICAID PROVIDER # 06656046" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com