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Organization
BLUE ELK FAMILY CLINIC LLC
Active
Organization
BLUE ELK FAMILY CLINIC LLC
Active
Other names
Blue Elk Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE DAVID SANCHEZ MD (OWNER/PHYSICIAN)
(812) 200-8265
Entity
Organization
Contact information
Practice address
50 E WILLOW ST STE C, NASHVILLE, IN 47448
(812) 200-8265
(833) 972-1963
Mailing address
8410 S 575 W, MORGANTOWN, IN 46160-8492
(414) 640-4945
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001485581
ANTHEM PROVIDER ID
—
05
—
300046197
—
IN
Enumeration date
07/22/2021
Last updated
07/22/2021
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