1225295447 NPI number — SANDERS AND ASSOCIATES. LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225295447 NPI number — SANDERS AND ASSOCIATES. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDERS AND ASSOCIATES. 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:
1225295447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 N TACOMA AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-3547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-257-7434
Provider Business Mailing Address Fax Number:
317-221-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 N TACOMA AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46220-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-257-7434
Provider Business Practice Location Address Fax Number:
317-221-7733
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SINGLE MEMBER
Authorized Official Telephone Number:
317-479-2315

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34002652A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000541815 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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