| Anthony J Anderson Md & Assoc Llc | |
|
1404 Pomerelle Ave Ste B Burley ID 83318-2013 | |
| (208) 878-9432 | |
| (208) 878-4576 |
| Full Name | Anthony J Anderson Md & Assoc Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1404 Pomerelle Ave Ste B, Burley, Idaho |
| Authorized Official Name and Position | Anthony Judd Anderson (OWNER) |
| Authorized Official Contact | 2088789432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anthony J Anderson Md & Assoc Llc 1404 Pomerelle Ave Ste B Burley ID 83318-2013 Ph: (208) 878-9432 | Anthony J Anderson Md & Assoc Llc 1404 Pomerelle Ave Ste B Burley ID 83318-2013 Ph: (208) 878-9432 |
| NPI Number | 1558604231 |
|---|---|
| Provider Enumeration Date | 04/01/2013 |
| Last Update Date | 03/18/2016 |
| Medicare PECOS PAC ID | 5597064709 |
|---|---|
| Medicare Enrollment ID | O20160421002366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558604231 | NPI | - | NPPES |
| 1508021726 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M-11018 (Idaho) | Primary |
| Provider Name | Anthony Judd Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508021726 PECOS PAC ID: 8527125798 Enrollment ID: I20110317000069 |
| Provider Name | Daelynn J Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265891261 PECOS PAC ID: 9830498369 Enrollment ID: I20160504001142 |
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