1689853111 NPI number — SONAL A SANGHVI PA-C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689853111 NPI number — SONAL A SANGHVI PA-C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SANGHVI

Provider First Name:

SONAL

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PA-C

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

PATEL

Provider Other First Name:

SONAL

Provider Other Middle Name:

A

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1689853111

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/18/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1236 E RUSHOLME ST

Provider Second Line Business Mailing Address:

SUITE 300

Provider Business Mailing Address City Name:

DAVENPORT

Provider Business Mailing Address State Name:

IA

Provider Business Mailing Address Postal Code:

52803-2434

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

563-324-2992

Provider Business Mailing Address Fax Number:

563-888-0499

Provider First Line Business Practice Location Address:

350 JOHN DEERE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MOLINE

Provider Business Practice Location Address State Name:

IL

Provider Business Practice Location Address Postal Code:

61265-6899

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

309-743-6700

Provider Business Practice Location Address Fax Number:

309-743-6709

Provider Enumeration Date:

11/01/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363AM0700X , with the licence number:  001859 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 001859 . This is a "PA LICENSE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 42106072402 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: CP8565 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 13238 . This is a "MEDICARE PART B GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 13238 . This is a "BCBS GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 0080200 . This is a "MEDICAID GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 5101108 . This is a "CSC RIVER DRIVE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 8122859 . This is a "BCBS GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 16-1801 . This is a "MEDICARE NGS GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 16D0387805 . This is a "CLIA RIVER DRIVE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".