Provider Demographics
NPI:1336856095
Name:ANDERSON CLINIC INC
Entity Type:Organization
Organization Name:ANDERSON CLINIC INC
Other - Org Name:ANDERSON CLINIC-RESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER-DELEGATED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-769-8423
Mailing Address - Street 1:2800 S SHIRLINGTON RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3614
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-521-3415
Practice Address - Street 1:1850 CENTENNIAL PARK DR STE 508
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1524
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-02
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2509OtherCAREFIRST PROVIDER NUMBER