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NPI Code Detail

MEDICARE: DR. SANDRA JILL ALTHAUS M.D.

MEDICARE: DR. SANDRA JILL ALTHAUS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD29060OR
22085R0202XDiagnostic Radiology Physician3082748-1205UT
32085R0202XDiagnostic Radiology Physician13664NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DQ837XOTHERCAMEDICARE TCR CA
4DQ837WOTHERNVMEDICARE TCR NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11326048018OTHERNPI
311306764OTHERCAQH

General Provider Information

NPI Number : 1326048018
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA JILL ALTHAUS M.D.
Provider Business Mailing Address
First Line : PO BOX 2087
Second Line :
City : CARSON CITY
State : NV
Zip : 89702-2087
Country : US
Telephone Number : 775-445-5500
Fax Number : 775-852-6902
Provider Business Practice Location Address
First Line : 2874 N CARSON ST
Second Line : SUITE 300
City : CARSON CITY
State : NV
Zip : 89706-0251
Country : US
Telephone Number : 775-445-5500
Fax Number : 775-852-6902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 12/18/2017

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