Provider Demographics
NPI:1366492217
Name:COX, SARA M (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:307 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1019
Mailing Address - Country:US
Mailing Address - Phone:989-506-2376
Mailing Address - Fax:616-754-9152
Practice Address - Street 1:709 S GREENVILLE WEST DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3514
Practice Address - Country:US
Practice Address - Phone:616-754-9146
Practice Address - Fax:616-754-9152
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004583363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004583OtherSTATE LICENSE NUMBER
MI5601004583OtherSTATE LICENSE NUMBER
P00271590Medicare PIN