1538100847 NPI number — MS. SARAH M GEORGE MSN, APRN,BC

Table of content: MS. SARAH M GEORGE MSN, APRN,BC (NPI 1538100847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538100847 NPI number — MS. SARAH M GEORGE MSN, APRN,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
SARAH
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN,BC
Provider Gender Code:
F

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:
1538100847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 SW RAMSEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-472-5501
Provider Business Mailing Address Fax Number:
541-472-5671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 OAK FOREST RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BLUFFTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29910-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-805-3006
Provider Business Practice Location Address Fax Number:
843-815-3737
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  201504879NP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP1143 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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