Provider Demographics
NPI:1366564056
Name:ILSA SANCHEZ MD PLLC
Entity type:Organization
Organization Name:ILSA SANCHEZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-3071
Mailing Address - Street 1:200 E MILITARY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1828
Mailing Address - Country:US
Mailing Address - Phone:901-737-3071
Mailing Address - Fax:
Practice Address - Street 1:200 E MILITARY RD STE 1
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1828
Practice Address - Country:US
Practice Address - Phone:901-737-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J575Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
F92885Medicare UPIN
ARR4284Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER