1811919350 NPI number — MICHAEL D SANDERS MD

Table of content: MICHAEL D SANDERS MD (NPI 1811919350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811919350 NPI number — MICHAEL D SANDERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1811919350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29116-1245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-395-4497
Provider Business Mailing Address Fax Number:
803-536-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4631 SAVANNAH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-247-2428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

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: 207Q00000X , with the licence number:  17688 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0146487 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20056902 . This is a "FIRST CHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5878065 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: LL1674 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000198573 . This is a "UNISON" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1548277627 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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