Provider Demographics
NPI:1679818413
Name:SANDS CLINIC, PA
Entity Type:Organization
Organization Name:SANDS CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:ARENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-719-4043
Mailing Address - Street 1:119 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5221
Mailing Address - Country:US
Mailing Address - Phone:910-719-4043
Mailing Address - Fax:910-997-7679
Practice Address - Street 1:119 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5221
Practice Address - Country:US
Practice Address - Phone:910-719-4043
Practice Address - Fax:910-817-7193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC35256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10005OtherBCBS
NC8910005Medicaid
NC2172611Medicare PIN
F34325Medicare UPIN