Provider Demographics
NPI:1114998150
Name:SANDHILLS PEDIATRICS
Entity Type:Organization
Organization Name:SANDHILLS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-692-2444
Mailing Address - Street 1:195 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5808
Mailing Address - Country:US
Mailing Address - Phone:910-692-2444
Mailing Address - Fax:910-692-3651
Practice Address - Street 1:195 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5808
Practice Address - Country:US
Practice Address - Phone:910-692-2444
Practice Address - Fax:910-692-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-28
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC50006FMedicare UPIN
NC60035FMedicare UPIN
NCG34461Medicare UPIN
NCG93927Medicare UPIN
NCF10206Medicare UPIN
NCC82375Medicare UPIN
NCH24746Medicare UPIN
NCF50054Medicare UPIN