1326027582 NPI number — DR. CARLETON T ANDERSON MD

Table of content: DR. CARLETON T ANDERSON MD (NPI 1326027582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326027582 NPI number — DR. CARLETON T ANDERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CARLETON
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
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:
1326027582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-8029
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 WILHITE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-275-8072
Provider Business Practice Location Address Fax Number:
317-275-8124
Provider Enumeration Date:
01/16/2006

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: 207ZC0500X , with the licence number:  30012 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 30012 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1069836 . This is a "MCD HMO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1841763-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64300122 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000363563 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 220019572 . This is a "TRAVELERS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2386529 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2434822000 . This is a "PASSPORT ADVANTAGE" identifier . This identifiers is of the category "OTHER".




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