MEDICARE: DR KEVIN ANDERSON & ASSOCIATES, PC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	CO1342	CO
2	152W00000X	Optometrist	OPT 1342	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD2107	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346422607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KEVIN ANDERSON & ASSOCIATES, PC.

Provider Business Mailing Address
First Line	:	4103 BOARDWALK DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-223-0592
Fax Number	:	970-377-1082

Provider Business Practice Location Address
First Line	:	4103 BOARDWALK DR
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5931
Country	:	US
Telephone Number	:	970-223-0592
Fax Number	:	970-377-1082

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DEBI WELBORN
Credential	:
Telephone Number	:	970-223-0592

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	01/12/2011

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