Healthcare Provider Details

I. General information

NPI: 1336294677
Provider Name (Legal Business Name): SANDSTONE EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N 1ST ST
BLYTHE CA
92225-1702
US

IV. Provider business mailing address

815 S PALAFOX ST STE. 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-7009
  • Fax: 800-305-3233
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES T MITCHELL
Title or Position: OWNER
Credential: MD
Phone: 800-444-7009