Provider Demographics
NPI:1649477308
Name:JAGJIT S SANDHU MD
Entity type:Organization
Organization Name:JAGJIT S SANDHU MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-824-2255
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-0218
Mailing Address - Country:US
Mailing Address - Phone:336-824-2255
Mailing Address - Fax:336-824-8333
Practice Address - Street 1:1508 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-0218
Practice Address - Country:US
Practice Address - Phone:336-824-2255
Practice Address - Fax:336-824-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2342919Medicare ID - Type Unspecified