Healthcare Provider Details

I. General information

NPI: 1275602427
Provider Name (Legal Business Name): ANDERSON ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 STATE ST
MADISON WV
25130-1139
US

IV. Provider business mailing address

167 STATE ST
MADISON WV
25130-1139
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1123
  • Fax: 304-369-9001
Mailing address:
  • Phone: 304-369-1123
  • Fax: 304-369-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number908
License Number StateWV

VIII. Authorized Official

Name: MR. CESAR M. ANDERSON
Title or Position: PRESIDENT
Credential: B.C.H.I.S.
Phone: 304-369-1123