1336856095 NPI number — THE ANDERSON CLINIC LLC

Table of content: (NPI 1336856095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336856095 NPI number — THE ANDERSON CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ANDERSON CLINIC LLC
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:
Provider Other Organization Name Type Code:
6
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:
1336856095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 S SHIRLINGTON RD STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22206-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-892-6500
Provider Business Mailing Address Fax Number:
703-521-3415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1886 METRO CENTER DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-892-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HORDGE
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER-DELEGATED OFFICAL
Authorized Official Telephone Number:
703-769-8423

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2509 . This is a "CAREFIRST PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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