1588621528 NPI number — SHAWN MICHAEL ANDERSON MD LLC

Table of content: (NPI 1588621528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588621528 NPI number — SHAWN MICHAEL ANDERSON MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAWN MICHAEL ANDERSON MD 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:
ANDERSON FAMILY CLINIC
Provider Other Organization Name Type Code:
3
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:
1588621528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 E 13TH
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
GROVE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-786-2226
Provider Business Mailing Address Fax Number:
918-786-8857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E 13TH
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-786-2226
Provider Business Practice Location Address Fax Number:
918-786-8857
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
918-786-2226

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com