1326446907 NPI number — SANDRA SPIERS, LLC

Table of content: (NPI 1326446907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326446907 NPI number — SANDRA SPIERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA SPIERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326446907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 WOODMONT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICAYUNE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39466-7658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-347-3029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-347-3029
Provider Business Practice Location Address Fax Number:
601-749-7100
Provider Enumeration Date:
12/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SPIERS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
601-347-3029

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04778509 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2831390 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00816371 . This is a "RR MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 640507572 . This is a "TRICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 5121500067 . This is a "MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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