1528149135 NPI number — SANDHILLS FAMILY MEDICINE, INC

Table of content: (NPI 1528149135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528149135 NPI number — SANDHILLS FAMILY MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS FAMILY MEDICINE, 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:
1528149135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 WEST 4TH
Provider Second Line Business Mailing Address:
PO BOX G
Provider Business Mailing Address City Name:
MULLEN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-546-2213
Provider Business Mailing Address Fax Number:
308-546-2263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 WEST 4TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MULLEN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-546-2213
Provider Business Practice Location Address Fax Number:
308-546-2263
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAVANAUGH BOYER
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
308-546-2213

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080065295 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2814196 . This is a "PHARMACY" identifier . This identifiers is of the category "OTHER".




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