Healthcare Provider Details

I. General information

NPI: 1003853409
Provider Name (Legal Business Name): SANDHILLS EMERGENCY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MEMORIAL DR
PINEHURST NC
28374-8710
US

IV. Provider business mailing address

120 APPLECROSS RD
PINEHURST NC
28374-8520
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-1000
  • Fax:
Mailing address:
  • Phone: 910-692-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier890172A
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. KRISTIN OLZARK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 910-692-8224