MEDICARE: DR. SANDRA KITSON M.D.

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	207Q00000X	Family Medicine Physician	M2370	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00269385	OTHER	TX	RR/MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8S1906	OTHER	TX	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1754475-02	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1720048614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA KITSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 847408
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7408
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 N LOOP 340
Second Line	:
City	:	BELLMEAD
State	:	TX
Zip	:	76705-2572
Country	:	US
Telephone Number	:	254-799-3690
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/11/2007

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Directions to “ DR. SANDRA KITSON M.D.” Practice Location

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