Provider Demographics
NPI:1598142580
Name:MEDECK, SARAH ASHLY (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ASHLY
Last Name:MEDECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:ATTN: MCXI-DEM
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5095
Mailing Address - Country:US
Mailing Address - Phone:254-288-8303
Mailing Address - Fax:254-288-8336
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:ATTN: MCXI-DEM
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8303
Practice Address - Fax:254-288-8336
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program