MICHAEL ANDERSON (NPI# 1194019406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194019406 |
| Entity Type | Individual |
| Full Name | MICHAEL ANDERSON |
| Credential | D.O. |
| Practice Address |
450 E Main St Rexburg ID 83440-2048 |
| Practice Telephone | 2083563691 |
| Mailing Telephone | 2083563691 |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2020-04-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
O-0885 | ID | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | ED0179A | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1346643038 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 202 Maplewood Ave, Ronceverte, WV 249701334 | 3046476529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598374712 | Michael Richard Anderson | Clinic/Center | 2560 Hubbell Ave, Des Moines, IA 50317-6102 | 2020-07-23 |
| 1881234623 | Michael Anderson | Durable Medical Equipment & Medical Supplies | 1203 N Hobart St Ste 34, Pampa, TX 79065-4664 | 2020-01-09 |
| 1164920898 | Michael Anderson | Counselor | 502 Mccarty Ln Ste 5, Jackson, OH 45640-7025 | 2018-01-29 |
| 1609324789 | Michael Anderson | Counselor | 75 Heaton Dr, Covington, GA 30016-0224 | 2016-09-16 |
| 1629438437 | Michael Anderson | Counselor | 145 Yonker Street, Barbeton, OH 44203 | 2016-03-07 |
| 1124406186 | Michael A Anderson | Family Medicine | 1000 Pocatello Creek Rd Ste E10, Pocatello, ID 83201-2953 | 2015-05-11 |
| 1679971683 | Michael Anderson | Occupational Therapist | 355 Saddlebrook Cir, Lewisville, NC 27023-8213 | 2014-12-08 |
| 1881004877 | Michael Anderson | Anesthesiology | 2345 E Thomas Rd Ste 400, Phoenix, AZ 85016 | 2014-04-30 |
| 1467871517 | Michael Callum Anderson | Counselor | 1881 Ne 26th St Ste 70, Wilton Manors, FL 33305-1425 | 2014-04-15 |
| 1871911958 | Michael Anderson | Physical Therapist | 9909 Mira Mesa Blvd Ste 260, San Diego, CA 92131-1064 | 2014-04-04 |
| Street Address |
450 E MAIN ST |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1396352142 | Karissa Thueson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2020-09-25 |
| 1376192674 | David Howard Anderson | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2019-09-09 |
| 1124676663 | Susan B Clark | Dietitian, Registered | 450 E Main St, Rexburg, ID 83440-2048 | 2019-08-28 |
| 1790278760 | Allen Terry Miller | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-13 |
| 1831682194 | Dorsie Thomas Sullenger | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-12 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1215471065 | Troy Hanson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2016-12-13 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| 1871941724 | Justin Shippen | Family Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2016-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538516471 | Anthony Christopher Derrico | Emergency Medicine | 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 | 2016-05-20 |
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1841679669 | Robert John Hagenberg IIi | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2015-05-26 |
| 1508003104 | Rocky Mountain Emergency Physicians, LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201 | 2009-01-19 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1710034988 | Kurt R Martyn | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1235216706 | John Kenneth Dudek | Emergency Medicine | 500 W Fort St, Medical Services, Boise, ID 83702-4501 | 2006-11-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.