Provider Demographics
NPI:1205194677
Name:SANDERS MEDICAL, LLC
Entity Type:Organization
Organization Name:SANDERS MEDICAL, LLC
Other - Org Name:TRISTATE INTEGRATIVE PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-449-2733
Mailing Address - Street 1:PO BOX 5328
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5328
Mailing Address - Country:US
Mailing Address - Phone:812-449-2733
Mailing Address - Fax:
Practice Address - Street 1:2516 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2404
Practice Address - Country:US
Practice Address - Phone:812-449-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048158A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200236040Medicaid
IN201069840Medicaid
IN201069840Medicaid
INM400075291Medicare PIN
INM100072533Medicare UPIN
G94136Medicare UPIN