MEDICARE: PAUL SANDEFUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1316369564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL SANDEFUR

Provider Business Mailing Address
First Line	:	PO BOX 601
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76097-0601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 S OLD BETSY RD APT 11
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-2458
Country	:	US
Telephone Number	:	214-707-8782
Fax Number	:	817-556-3445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	01/07/2014

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Directions to “ PAUL SANDEFUR ” Practice Location

Language	Start Address	Practice Location

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