Healthcare Provider Details

I. General information

NPI: 1427051044
Provider Name (Legal Business Name): JILL M SANDERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL M SANDERS-ADKINS PA-C

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PATRICK AVE
URBANA OH
43078-2302
US

IV. Provider business mailing address

3250 MIDDLE URBANA RD
SPRINGFIELD OH
45502-9285
US

V. Phone/Fax

Practice location:
  • Phone: 937-484-6157
  • Fax: 937-484-6181
Mailing address:
  • Phone: 937-399-7777
  • Fax: 937-399-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001833
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50-001833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: