Provider Demographics
NPI:1265193916
Name:SANDSTONE CLINIC LLC
Entity type:Organization
Organization Name:SANDSTONE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:435-220-1051
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ROCK POINT
Mailing Address - State:AZ
Mailing Address - Zip Code:86545-0394
Mailing Address - Country:US
Mailing Address - Phone:928-659-4141
Mailing Address - Fax:928-659-4299
Practice Address - Street 1:49314 HIGHWAY US-191
Practice Address - Street 2:
Practice Address - City:ROCK POINT
Practice Address - State:AZ
Practice Address - Zip Code:86545-8654
Practice Address - Country:US
Practice Address - Phone:928-659-4141
Practice Address - Fax:928-659-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies