Provider Demographics
NPI:1700931995
Name:GEOFFREY C. ANDERSON, PHD PC
Entity Type:Organization
Organization Name:GEOFFREY C. ANDERSON, PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-330-5400
Mailing Address - Street 1:11929 ELM ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4364
Mailing Address - Country:US
Mailing Address - Phone:402-330-5400
Mailing Address - Fax:
Practice Address - Street 1:11929 ELM ST
Practice Address - Street 2:SUITE 12
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4364
Practice Address - Country:US
Practice Address - Phone:402-330-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099822Medicare ID - Type Unspecified