Provider Demographics
NPI:1942315759
Name:FAMILY PHYSICIANS OF ANDERSON, PC, INC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF ANDERSON, PC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:JULIANA
Authorized Official - Last Name:CARRANCEJIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-683-3180
Mailing Address - Street 1:141 W 22ND ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4304
Mailing Address - Country:US
Mailing Address - Phone:765-683-3180
Mailing Address - Fax:
Practice Address - Street 1:141 W 22ND ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4304
Practice Address - Country:US
Practice Address - Phone:765-683-3180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200365250AMedicaid
IN000000214488OtherANTHEM BCBS
194250AMedicare ID - Type Unspecified
F39842Medicare UPIN