Basic Information
| Provider Information | |||||||||
| NPI: | 1992005649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RT (R) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PAWNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625589149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178363231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E CARPENTER ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627025324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175446464 | ||||||||
| FaxNumber: | 2175287541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 10/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | 233818 | IL | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.