=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902182371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXTENDED CARE MEDICAL ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2011
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 256 HONEYSUCKLE RD STE 20
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36305-1168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-699-3320
-----------------------------------------------------
Fax | 334-699-3342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6289
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36302-6289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-699-3320
-----------------------------------------------------
Fax | 334-699-3341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MD
-----------------------------------------------------
Name | DR. BOBBY STEPHEN SANDERS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 334-699-3320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------