Provider Demographics
NPI:1821083627
Name:SANDERS COMPREHENSIVE CLINIC, INC.
Entity Type:Organization
Organization Name:SANDERS COMPREHENSIVE CLINIC, INC.
Other - Org Name:SANDEL'S PRIMARY HEALTH CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:FFRENCH-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-635-9611
Mailing Address - Street 1:7750 PALM RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4215
Mailing Address - Country:US
Mailing Address - Phone:813-635-9611
Mailing Address - Fax:813-635-0211
Practice Address - Street 1:7750 PALM RIVER ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4215
Practice Address - Country:US
Practice Address - Phone:813-635-9611
Practice Address - Fax:813-635-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68819207R00000X
FLARNP2602032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302385100Medicaid
FL302385100Medicaid
K7592Medicare PIN
FLS72793Medicare UPIN