Provider Demographics
NPI:1003017492
Name:SANDAL, INC
Entity Type:Organization
Organization Name:SANDAL, INC
Other - Org Name:EMERSON HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DIP
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-428-1900
Mailing Address - Street 1:2910 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2519
Mailing Address - Country:US
Mailing Address - Phone:304-428-1900
Mailing Address - Fax:304-428-1976
Practice Address - Street 1:2910 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-2519
Practice Address - Country:US
Practice Address - Phone:304-428-1900
Practice Address - Fax:304-428-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14444305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049665000Medicaid
WV0049665000Medicaid
WVC35136Medicare UPIN