MEDICARE: ANDERSON AUDIOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A-010	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164582540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON AUDIOLOGY PC

Provider Business Mailing Address
First Line	:	3120 S RAINBOW BLVD #202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6235
Country	:	US
Telephone Number	:	702-233-4327
Fax Number	:	702-233-8837

Provider Business Practice Location Address
First Line	:	3120 S RAINBOW BLVD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6235
Country	:	US
Telephone Number	:	702-233-4327
Fax Number	:	702-233-8837

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID E ANDERSON
Credential	:	AU.D.,CCC-A
Telephone Number	:	702-233-4327

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	01/20/2009

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Directions to “ANDERSON AUDIOLOGY PC ” Practice Location

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