MEDICARE: DR. ANDREW L ARCHER D.O.

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	208600000X	Surgery Physician	34006981A	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00133425	OTHER	OH	RAILROAD MEDICARE

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
2	98259	OTHER	OH	NATIONWIDE HEALTH PLAN
3	D06981	OTHER	OH	HUMANA/CHOICECARE
4	34006981A	OTHER	OH	MEDICAL LICENSE
5	3805308	OTHER	OH	CIGNA
6	1702273	OTHER	OH	UNITED HEALTHCARE
7	421534506	OTHER	OH	CHAMPUS/TRICARE
9	445020003	OTHER	OH	CARESOURCE
10	7582436	OTHER	OH	AETNA
11	220226702	OTHER	OH	DEPT. OF LABOR WC
12	000000334026	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1336142603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW L ARCHER D.O.

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL
Second Line	:	STE 550
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3794
Country	:	US
Telephone Number	:	937-762-1310
Fax Number	:	937-522-8493

Provider Business Practice Location Address
First Line	:	7700 WASHINGTON VILLAGE DR STE 130
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4094
Country	:	US
Telephone Number	:	937-531-0195
Fax Number	:	937-531-0196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/06/2022

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