Basic Information
| Provider Information | |||||||||
| NPI: | 1649810805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDERSON CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 ARMY NAVY DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7035213415 | ||||||||
| Practice Location | |||||||||
| Address1: | 3299 WOODBURN RD STE 480 | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220037333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038926500 | ||||||||
| FaxNumber: | 7035213415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2020 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | HORDGE | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7037698423 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ANDERSON CLINIC INC | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2509 | 01 | BCBS | OTHER |