Healthcare Provider Details

I. General information

NPI: 1720276702
Provider Name (Legal Business Name): SUZANNE BETH SACHS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 8TH ST
GORDON NE
69343-1123
US

IV. Provider business mailing address

300 E 8TH ST
GORDON NE
69343-1123
US

V. Phone/Fax

Practice location:
  • Phone: 308-282-1442
  • Fax: 308-282-1428
Mailing address:
  • Phone: 308-282-1442
  • Fax: 308-282-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1342
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: