Andersen Family Care
Organization Active NPI Primary Care Clinic/Center · Meridian, ID
NPI 1124741277 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1124741277
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- ANDERSEN FAMILY CARE
- Practice address
- 1494 West Ustick Rd
110
Meridian, ID 83646 - Phone
- (208) 908-7797
- NPI assigned
- Sep 23, 2022
- Organization subpart
- No
Authorized official
- Name
- Dallin Andersen, PA-C
- Title
- Owner
- Phone
- (208) 954-0101
Practitioners 4
-
Dallin Andersen, PA-C
-
Bretta Lee Cyr, PA
-
Lindsay Ann Erstad, PA-C
-
Raquel Renee Kacin, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221031000939 | ID | Part B Supplier - Clinic/Group Practice | 4688041932 |
Receives reassigned benefits from 3 practitioners Practice locations: Meridian, ID |
National Provider Directory
Locations
1494 W Ustick Rd
Ste 110
Meridian, ID 83646
Phone (208) 908-7797
3167 W Belltower Dr
Ste 120
Meridian, ID 83646
Phone (208) 908-7797
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
1494 West Ustick Rd
110
Meridian, ID 83646
Mailing address
1494 West Ustick Rd
110
Meridian, ID 83646
Phone (208) 908-7797
Other names
- Andersen Family Care P.L.L.C
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | andersenfamilycare@gmail.com | Direct |
Other providers in Meridian, ID
- Anchor Pointe Inc
- Anchored & Renewed Hope Counseling
- Ancora Hospice & Palliative Services, LLC
- Ancora Hospice & Palliative Services, LLC
- Alpha Tamir Anders
- Dallin Andersen
- Joseph John Andersen
- Amanda Lee Anderson
- Amy Rose Anderson
- Autumn Rose Anderson
All providers in Meridian, ID · Primary Care Clinic/Center in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.