Provider Demographics
NPI:1346422607
Name:DR KEVIN ANDERSON & ASSOCIATES, PC.
Entity type:Organization
Organization Name:DR KEVIN ANDERSON & ASSOCIATES, PC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-223-0592
Mailing Address - Street 1:4103 BOARDWALK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5931
Mailing Address - Country:US
Mailing Address - Phone:970-223-0592
Mailing Address - Fax:970-377-1082
Practice Address - Street 1:4103 BOARDWALK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5931
Practice Address - Country:US
Practice Address - Phone:970-223-0592
Practice Address - Fax:970-377-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR KEVIN ANDERSON & ASSOCIATES, PC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1342152W00000X
COCO1342332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODD2107OtherRAILROAD MEDICARE
CO04011250Medicaid
CO5402970001Medicare NSC
CO04011250Medicaid
COC800350Medicare PIN