Provider Demographics
NPI:1437163805
Name:SANDBERG, JAMES C (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2412
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:175 S UNION BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-365-1951
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002246363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60703733Medicaid
COC806053Medicare PIN
CO60703733Medicaid