MEDICARE: SANDRA L. PARKS, M.D., LLC

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	305R00000X	Preferred Provider Organization	20911	NE

General Provider Information

NPI Number	:	1346793643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA L. PARKS, M.D., LLC

Provider Business Mailing Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-4295
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. SANDRA L PARKS
Credential	:
Telephone Number	:	402-228-4295

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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