Healthcare Provider Details

I. General information

NPI: 1265193916
Provider Name (Legal Business Name): SANDSTONE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49314 HIGHWAY US-191
ROCK POINT AZ
86545-8654
US

IV. Provider business mailing address

PO BOX 394
ROCK POINT AZ
86545-0394
US

V. Phone/Fax

Practice location:
  • Phone: 928-659-4141
  • Fax: 928-659-4299
Mailing address:
  • Phone: 928-659-4141
  • Fax: 928-659-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. IVAN JONES
Title or Position: OWNER
Credential: BSN
Phone: 435-220-1051