MEDICARE: MEDICAL OFFICES OF DEVRY ANDERSON

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	261QP2300X	Primary Care Clinic/Center	N3448	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578870622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL OFFICES OF DEVRY ANDERSON

Provider Business Mailing Address
First Line	:	1033 S FORT HOOD ST STE 200
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76541-7436
Country	:	US
Telephone Number	:	254-630-9366
Fax Number	:	254-634-7700

Provider Business Practice Location Address
First Line	:	1033 S FORT HOOD ST STE 200
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76541-7436
Country	:	US
Telephone Number	:	254-630-9366
Fax Number	:	254-634-7700

Authorized Official
Title or Position	:	CEO
Name	:	DR. DEVRY CALVIN ANDERSON
Credential	:	M.D.
Telephone Number	:	254-630-9366

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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