Basic Information
Provider Information | |||||||||
NPI: | 1235132606 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SADY | ||||||||
FirstName: | STANLEY | ||||||||
MiddleName: | P. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. , PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1400 E BOULDER ST | ||||||||
Address2: | PSSB SUITE 1200 | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809095533 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7193656999 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4150 V ST | ||||||||
Address2: | PSSB SUITE 1200 | ||||||||
City: | SACRAMENTO | ||||||||
State: | CA | ||||||||
PostalCode: | 958171460 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9167347985 | ||||||||
FaxNumber: | 9167342975 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2005 | ||||||||
LastUpdateDate: | 02/01/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | DR.0057730 | CO | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | Z9598 | 05 | NM |   | MEDICAID | 209441005 | 05 | MO |   | MEDICAID | 50150537 | 05 | CO |   | MEDICAID | 52628 | 05 | NM |   | MEDICAID | NM009C89 | 01 | NM | BLUE CROSS BLUE SHEILD | OTHER | 7613812 | 05 | NC |   | MEDICAID | 474776 | 05 | AZ |   | MEDICAID | 961251 | 01 | NM | PRONET / AETNA | OTHER |