Provider Demographics
NPI:1205813755
Name:SENSENBRENNER PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:SENSENBRENNER PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SENSENBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-887-1101
Mailing Address - Street 1:8821 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6594
Mailing Address - Country:US
Mailing Address - Phone:704-887-1101
Mailing Address - Fax:704-887-1102
Practice Address - Street 1:8821 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6594
Practice Address - Country:US
Practice Address - Phone:704-887-1101
Practice Address - Fax:704-887-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2346502Medicare PIN