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General NPI Number Information
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NPI Number | 1659516680
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Entity Type | Organization
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Legal Business Name | SANDIA NEUROLOGY GROUP PA
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1515 10TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4404
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Country | US
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Telephone | 940-723-7000
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Fax | 940-723-7007
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Provider Business Mailing Address
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Address Line | 1515 10TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4404
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Country | US
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Telephone | 940-723-7000
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Fax | 940-723-7007
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SANDRA CHRISTOPHER
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Credential |
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Telephone | 940-723-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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