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NPI Code Detail

MEDICARE: DARCY JEAN ANDERSON PA-C

MEDICARE:   DARCY JEAN ANDERSON  PA-C
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
1363A00000XPhysician Assistant085-001994IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K04485OTHERILMEDICARE IND. PROVIDER #

General Provider Information

NPI Number : 1407826589
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARCY JEAN ANDERSON PA-C
Provider Business Mailing Address
First Line : 2570 24TH ST
Second Line : SUITE 124
City : ROCK ISLAND
State : IL
Zip : 61201-5394
Country : US
Telephone Number : 309-779-3670
Fax Number : 309-779-3675
Provider Business Practice Location Address
First Line : 2570 24TH ST
Second Line : SUITE 124
City : ROCK ISLAND
State : IL
Zip : 61201-5394
Country : US
Telephone Number : 309-779-3670
Fax Number : 309-779-3675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 02/05/2015

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Directions to “ DARCY JEAN ANDERSON PA-C” Practice Location

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