Provider Demographics
NPI:1801002852
Name:ANDERSON CLINIC, P.C.
Entity Type:Organization
Organization Name:ANDERSON CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-247-0119
Mailing Address - Street 1:5610 CRAWFORDSVILLE RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-3727
Mailing Address - Country:US
Mailing Address - Phone:317-247-0119
Mailing Address - Fax:317-247-0614
Practice Address - Street 1:5610 CRAWFORDSVILLE RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3727
Practice Address - Country:US
Practice Address - Phone:317-247-0119
Practice Address - Fax:317-247-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty