| Tyler Lee Sanders, PA-C | |
|
620 E Monroe St, Mexico, MO 65265-2919 | |
| (660) 728-0061 | |
| Not Available |
| Full Name | Tyler Lee Sanders |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 620 E Monroe St, Mexico, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033784111 | NPI | - | NPPES |
| 220099242 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 2021010812 (Missouri) | Primary |
| Entity Name | The Curators of the University of Missouri |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235126921 PECOS PAC ID: 4486759560 Enrollment ID: O20070418000290 |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Lee Sanders, PA-C Po Box 843966, Kansas City, MO 64184-3966 Ph: (573) 884-3300 | Tyler Lee Sanders, PA-C 620 E Monroe St, Mexico, MO 65265-2919 Ph: (660) 728-0061 |
Jasmine Lynette Johnese, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 340 Kelley Pkwy, Mexico, MO 65265 Phone: 573-582-1234 Fax: 573-582-1212 |
Ashlee Dougherty, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 600 Medical Park Dr, Mexico, MO 65265 Phone: 573-581-8500 Fax: 573-581-5397 |