=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669898607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LTC SOLUTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2014
-----------------------------------------------------
Last Update Date | 07/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 604 NORTH MAIN
-----------------------------------------------------
City | GORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74435-0479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-520-0859
-----------------------------------------------------
Fax | 918-489-5260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 479
-----------------------------------------------------
City | GORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74435-0479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-520-0859
-----------------------------------------------------
Fax | 918-489-5260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM R ANDERSON
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 918-520-0859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2597
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------