Basic Information
| Provider Information | |||||||||
| NPI: | 1851376347 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSEN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 E DAKOTA AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802471314 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10240 PARK MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033384545 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 42617 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 121183800 | 05 | WY | MEDICAID | 200376720A | 05 | KS | MEDICAID | 1851376347 | 05 | UT | MEDICAID | 929010 | 05 | AZ | MEDICAID | 20922850 | 05 | CO | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | P00720342 | 01 | NE | RR MCR NE | OTHER | 1851376347 | 05 | SD | MEDICAID | 28102517 | 05 | NM | MEDICAID | 0062769 | 05 | OH | MEDICAID | 10025709000 | 05 | NE | MEDICAID | P00312918 | 01 | CO | RR RIA MEDICARE | OTHER | 026810 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | P00385462 | 01 | CO | RR MIC MEDICARE | OTHER |