Provider Demographics
NPI:1134772270
Name:SANDSTONE MEDICAL
Entity type:Organization
Organization Name:SANDSTONE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:DERAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-825-8670
Mailing Address - Street 1:1803 W WHITE OAK TER STE B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3675
Mailing Address - Country:US
Mailing Address - Phone:281-203-0070
Mailing Address - Fax:936-582-0410
Practice Address - Street 1:795 FISH CREEK THOROUGHFARE STE 270
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316
Practice Address - Country:US
Practice Address - Phone:281-203-0070
Practice Address - Fax:936-436-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care