MEDICARE: DR. ARMANDO C SANDOVAL 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
1	207Q00000X	Family Medicine Physician	21335	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21335	OTHER	KY	KY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	080113180	OTHER	KY	KY RR MCR
4	000000047428	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1659389294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARMANDO C SANDOVAL M.D.

Provider Business Mailing Address
First Line	:	1413 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-827-9803
Fax Number	:	270-827-8966

Provider Business Practice Location Address
First Line	:	1413 N ELM ST
Second Line	:	SUITE 101
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-827-9803
Fax Number	:	270-827-8966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/03/2015

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