Active NPI
Ed William Anderson Jr.
- Home Modifications Contractor
- Suffolk, VA
National Provider Identifier
1861033540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 2705128261
- Practice address
- 401 Linden Ave
Suffolk, VA 23434-5827 - Phone
- (757) 749-5579
- NPI assigned
- Oct 3, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 2705128261 | VA | Primary |
Addresses
Primary practice location
401 Linden Ave
Suffolk, VA 23434-5827
Mailing address
401 Linden Ave
Suffolk, VA 23434-5827
Phone (757) 749-5579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2705128261 | VA | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570060800000",
"number": "1861033540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 LINDEN AVE",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234345827",
"telephone_number": "757-749-5579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 LINDEN AVE",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234345827",
"telephone_number": "757-749-5579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "ED",
"middle_name": "WILLIAM",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-03",
"last_updated": "2019-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Contractor, Home Modifications",
"state": "VA",
"license": "2705128261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.