Mickey Dale Anderson, MD
Individual provider Active NPI Surgery Physician · Bardstown, KY
NPI 1497728323 · NPPES record last updated May 6, 2019
Key facts
- NPI
- 1497728323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 20844 (KY)
- Practice address
- 118 Patriot Dr
Suite 203
Bardstown, KY 40004-9093 - Phone
- (502) 348-5588
- Fax
- (502) 348-1046
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040907000323 | KY | Practitioner - General Surgery | 6305812850 | Practice locations: Bardstown, KY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20844 | KY | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurosurgical Associates PSC | Current | Accepting new patients |
Interoperability endpoints
- mickeyanderson@kysjhspe.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20844 | KY | Yes |
Addresses
Primary practice location
118 Patriot Dr
Suite 203
Bardstown, KY 40004-9093
Mailing address
PO Box 936
London, KY 40743-0936
Phone (606) 330-7840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64208440 | Medicaid | KY |
Other providers in Bardstown, KY
- Algwydon Inc
- Almcare, LLC
- Alternative Health Solutions LLC
- Anderson & Bowlds PLLC
- Frances Nicole Anderson
- Andrea G. Haydon, DMD PLLC
- Annandlee, PLLC
- Ashley Strange, LCSW, PLLC
- Associates in General Surgery,PSC
- Astra Recovery Centers, LLC
All providers in Bardstown, KY · Surgery Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2019. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.