Healthcare Provider Details

I. General information

NPI: 1639596935
Provider Name (Legal Business Name): CHRISTOPHER ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N MICHIGAN ST
PITTSBURG KS
66762-2543
US

IV. Provider business mailing address

911 E CENTENNIAL DR
PITTSBURG KS
66762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 620-253-7170
  • Fax: 620-231-9811
Mailing address:
  • Phone: 620-231-5130
  • Fax: 620-235-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: