Provider Demographics
NPI:1073166690
Name:ANDERSON MEDICAL PROCEDURES LLC
Entity Type:Organization
Organization Name:ANDERSON MEDICAL PROCEDURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-227-3086
Mailing Address - Street 1:1355 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4368
Mailing Address - Country:US
Mailing Address - Phone:970-484-4620
Mailing Address - Fax:970-484-4645
Practice Address - Street 1:1355 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4368
Practice Address - Country:US
Practice Address - Phone:970-484-4620
Practice Address - Fax:970-484-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty