=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568002723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ANDERSON CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2020
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10716 RICHMOND HWY
-----------------------------------------------------
City | LORTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22079-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-892-6500
-----------------------------------------------------
Fax | 703-521-3415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 S SHIRLINGTON RD STE 1100
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22206-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-892-6500
-----------------------------------------------------
Fax | 703-521-3415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | BETSY CHAPPELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-769-8423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QV0200X
-----------------------------------------------------
Taxonomy Name | VA Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------