1124140835 NPI number — SANDRA FIELDS NEAL & ASSOC INC

Table of content: (NPI 1124140835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124140835 NPI number — SANDRA FIELDS NEAL & ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA FIELDS NEAL & ASSOC INC
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:
1124140835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19646
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49019-0646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-381-5213
Provider Business Mailing Address Fax Number:
269-381-4375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 S BURDICK ST
Provider Second Line Business Practice Location Address:
SUITE 254
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-381-5213
Provider Business Practice Location Address Fax Number:
269-381-4375
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS NEAL
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
269-381-5213

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X , with the licence number:  6801059501 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com