| Mark Sandefur, | |
|
1200 Grant Blvd W, Wabasha, MN 55981-1042 | |
| (608) 782-7300 | |
| Not Available |
| Full Name | Mark Sandefur |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 1200 Grant Blvd W, Wabasha, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255674073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 60108 (Minnesota) | Primary |
| Entity Name | Emergency Physicians Professional Association |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801871934 PECOS PAC ID: 9537072657 Enrollment ID: O20031106000068 |
| Entity Name | Saint Elizabeths Hospital Of Wabasha Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659355600 PECOS PAC ID: 5092619387 Enrollment ID: O20031119000811 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Sandefur, 1836 South Ave, La Crosse, WI 54601-5429 Ph: (608) 782-7300 | Mark Sandefur, 1200 Grant Blvd W, Wabasha, MN 55981-1042 Ph: (608) 782-7300 |
Dr. Paul C Nystrom, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1200 Grant Blvd W, Wabasha, MN 55981 Phone: 651-565-4531 | |
Dr. Nicole Marie Wallis, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1200 Grant Blvd W, Wabasha, MN 55981 Phone: 651-565-4531 |