Healthcare Provider Details

I. General information

NPI: 1134196348
Provider Name (Legal Business Name): SANDRA BAIER MCCARTHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ELM ST N
SAUK CENTRE MN
56378-1010
US

IV. Provider business mailing address

425 ELM ST N
SAUK CENTRE MN
56378-1010
US

V. Phone/Fax

Practice location:
  • Phone: 855-295-0058
  • Fax:
Mailing address:
  • Phone: 320-352-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2116
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number9293
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: