Provider Demographics
NPI:1912028689
Name:SANDHILLS FAMILY MEDICINE
Entity Type:Organization
Organization Name:SANDHILLS FAMILY MEDICINE
Other - Org Name:SANDHILLS FAMILY MEDICINE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CAVANAUGH-BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-546-2213
Mailing Address - Street 1:207 WEST 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:MULLEN
Mailing Address - State:NE
Mailing Address - Zip Code:69152
Mailing Address - Country:US
Mailing Address - Phone:308-546-2213
Mailing Address - Fax:308-546-2263
Practice Address - Street 1:207 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152-1555
Practice Address - Country:US
Practice Address - Phone:308-546-2213
Practice Address - Fax:308-546-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2814196OtherPHARMACY NABP
NE2814196OtherPHARMACY NABP
NE2814196OtherPHARMACY NABP