Basic Information
| Provider Information | |||||||||
| NPI: | 1114342243 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANCHOR MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 LOCKHEED DR | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258138962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042535155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 LOCKHEED DR | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258138962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042535155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2014 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | TATE | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3042535155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSN, APRN, FNP-BC | ||||||||
| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 51350 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.