Anthony J Anderson MD & Assoc LLC
Organization Active NPI Family Medicine Physician · Burley, ID
NPI 1558604231 · NPPES record last updated Mar 18, 2016
Key facts
- NPI
- 1558604231
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M-11018 (ID)
- Legal business name
- ANTHONY J ANDERSON MD & ASSOC LLC
- Practice address
- 1404 Pomerelle Ave Ste B
Burley, ID 83318-2013 - Phone
- (208) 878-9432
- Fax
- (208) 878-4576
- NPI assigned
- Apr 1, 2013
- Organization subpart
- No
Authorized official
- Name
- Anthony Judd Anderson, MD
- Title
- Owner
- Phone
- (208) 878-9432
Practitioners 5
-
Daelynn Jo Smith, FNP
-
Logan Nielson, PA-C
-
Ronald Bret Campbell, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160421002366 | ID | Part B Supplier - Clinic/Group Practice | 5597064709 |
Receives reassigned benefits from 4 practitioners Practice locations: Burley, ID |
National Provider Directory
Locations
1404 Pomerelle Ave
Ste B
Burley, ID 83318
Phone (208) 878-9432
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | M-11018 | ID | Yes |
Addresses
Primary practice location
1404 Pomerelle Ave Ste B
Burley, ID 83318-2013
Mailing address
1404 Pomerelle Ave Ste B
Burley, ID 83318-2013
Phone (208) 878-9432
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508021726 | Medicaid | ID |
Other providers in Burley, ID
- Anthony J Anderson
- Kasandra Jo Anderson
- Troy Michael Anderson
- Anesthesia West, PA
- Heather Tanner Anthon
- Staci Armstrong
- Alice K Ash
- Lacie Shilo Asher
- Aspenwood Counseling and Behavior Center
- Assisted Living Concepts Inc
All providers in Burley, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2016. 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.