Provider Demographics
NPI:1356391551
Name:PAUL ANDERSON
Entity type:Organization
Organization Name:PAUL ANDERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NORGAAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-1808
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4342
Mailing Address - Country:US
Mailing Address - Phone:712-262-1808
Mailing Address - Fax:712-262-5532
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:712-262-1808
Practice Address - Fax:712-262-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298810Medicaid
IAI8771Medicare PIN