Provider Demographics
NPI:1992701296
Name:ANDREW C. SAMBELL M.D.P.A.
Entity type:Organization
Organization Name:ANDREW C. SAMBELL M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAMBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-938-8526
Mailing Address - Street 1:1626 W HWY 287 BUS.
Mailing Address - Street 2:SUITE #103
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-938-8526
Mailing Address - Fax:972-923-0288
Practice Address - Street 1:1626 W HWY 287 BUS
Practice Address - Street 2:STE 103
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4728
Practice Address - Country:US
Practice Address - Phone:972-938-8526
Practice Address - Fax:972-923-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030936105Medicaid
TX030936103Medicaid
TX030936104Medicaid
TX8G9310Medicare PIN
TX8G9309Medicare PIN
TX030936104Medicaid
TX030936105Medicaid