1902903586 NPI number — HEATHER S ANDERSON M.D.

Table of content: HEATHER S ANDERSON M.D. (NPI 1902903586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902903586 NPI number — HEATHER S ANDERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
HEATHER
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1902903586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 875743
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64187-5743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-215-5008
Provider Business Mailing Address Fax Number:
816-447-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10977 GRANADA LN
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-215-5008
Provider Business Practice Location Address Fax Number:
816-447-3960
Provider Enumeration Date:
09/17/2006

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: 2084N0400X , with the licence number:  04-30906 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00251353 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35761019 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 200331610A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207369000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com