Healthcare Provider Details

I. General information

NPI: 1447095237
Provider Name (Legal Business Name): SANDERS FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WILLAMETTE ST STE 1
EUGENE OR
97405-3309
US

IV. Provider business mailing address

3225 WILLAMETTE ST STE 1
EUGENE OR
97405-3309
US

V. Phone/Fax

Practice location:
  • Phone: 541-813-5256
  • Fax: 541-229-1238
Mailing address:
  • Phone: 541-813-5256
  • Fax: 541-229-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. AMANDAJO SANDERS
Title or Position: PHYSICIAN/ OWNER
Credential: DO
Phone: 517-488-6546