Provider Demographics
NPI:1063003358
Name:ANDERSON, THOMAS BERT
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BERT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 13TH ST S
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-2002
Mailing Address - Country:US
Mailing Address - Phone:701-947-2201
Mailing Address - Fax:
Practice Address - Street 1:701 13TH ST S
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-2002
Practice Address - Country:US
Practice Address - Phone:701-947-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant