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
—
—
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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