Provider Demographics
NPI:1659516680
Name:SANDIA NEUROLOGY GROUP PA
Entity Type:Organization
Organization Name:SANDIA NEUROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-723-7000
Mailing Address - Street 1:1515 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4404
Mailing Address - Country:US
Mailing Address - Phone:940-723-7000
Mailing Address - Fax:940-723-7007
Practice Address - Street 1:1515 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4404
Practice Address - Country:US
Practice Address - Phone:940-723-7000
Practice Address - Fax:940-723-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2005472-01Medicaid
TX0A0333Medicare PIN