1235132606 NPI number — DR. STANLEY P. SADY M.D. , PHD

Table of content: DR. STANLEY P. SADY M.D. , PHD (NPI 1235132606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235132606 NPI number — DR. STANLEY P. SADY M.D. , PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADY
Provider First Name:
STANLEY
Provider Middle Name:
P.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. , PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235132606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E BOULDER ST
Provider Second Line Business Mailing Address:
PSSB SUITE 1200
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-5533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-365-6999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 V ST
Provider Second Line Business Practice Location Address:
PSSB SUITE 1200
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7985
Provider Business Practice Location Address Fax Number:
916-734-2975
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  DR.0057730 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z9598 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209441005 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50150537 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52628 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM009C89 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 7613812 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 474776 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 961251 . This is a "PRONET / AETNA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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