Healthcare Provider Details

I. General information

NPI: 1073166690
Provider Name (Legal Business Name): ANDERSON MEDICAL PROCEDURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RIVERSIDE AVE
FORT COLLINS CO
80524-4368
US

IV. Provider business mailing address

1355 RIVERSIDE AVE
FORT COLLINS CO
80524-4368
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4620
  • Fax: 970-484-4645
Mailing address:
  • Phone: 970-484-4620
  • Fax: 970-484-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES ANDERSON
Title or Position: SOLE OWNER
Credential: DPM
Phone: 970-227-3086