1679850341 NPI number — MS. ANNE C UNDERHILL PA

Table of content: MS. ANNE C UNDERHILL PA (NPI 1679850341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679850341 NPI number — MS. ANNE C UNDERHILL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERHILL
Provider First Name:
ANNE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAULK
Provider Other First Name:
ANNE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679850341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3027 N CIRCLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-1179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-776-3216
Provider Business Mailing Address Fax Number:
719-776-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3027 N CIRCLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-1179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-776-3216
Provider Business Practice Location Address Fax Number:
719-776-3220
Provider Enumeration Date:
11/09/2011

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: 363AM0700X , with the licence number:  PA.0000563 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19870051 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".