Provider Demographics
NPI:1770245482
Name:ANDERSON ACCESS SERVICES LLC
Entity Type:Organization
Organization Name:ANDERSON ACCESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-678-4077
Mailing Address - Street 1:2190 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9234
Mailing Address - Country:US
Mailing Address - Phone:409-678-4077
Mailing Address - Fax:
Practice Address - Street 1:2190 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9234
Practice Address - Country:US
Practice Address - Phone:409-678-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)