Provider Demographics
NPI:1427051044
Name:SANDERS, JILL M (PA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:SANDERS-ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3250 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9285
Mailing Address - Country:US
Mailing Address - Phone:937-399-7777
Mailing Address - Fax:937-399-6794
Practice Address - Street 1:204 PATRICK AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2302
Practice Address - Country:US
Practice Address - Phone:937-484-6157
Practice Address - Fax:937-484-6181
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001833207Q00000X
OH50.001833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP91190Medicare UPIN
OHPA19622Medicare PIN