Provider Demographics
NPI:1396817722
Name:KENNETH W SANDERS PLLC
Entity type:Organization
Organization Name:KENNETH W SANDERS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-6590
Mailing Address - Street 1:PO BOX 44072
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134
Mailing Address - Country:US
Mailing Address - Phone:318-797-5602
Mailing Address - Fax:318-797-5600
Practice Address - Street 1:2800 YOUREE DRIVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-797-5602
Practice Address - Fax:318-797-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Not Answered207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Not Answered235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherOSCHNER HEALTH CARE
=========OtherMULTIPLAN
=========OtherHEALTH PLUS
=========OtherGROUP BENEFITS
=========OtherAMERICAN LIFE CARE
=========OtherFIRST HEALTH
=========OtherHUMANA TRICARE
=========OtherGUID STAR
=========OtherCIGNA
=========OtherUNITED HEALTHCARE
=========OtherHEALTH PLUS