Provider Demographics
NPI:1861548554
Name:JAMES J SARDO MD INC
Entity type:Organization
Organization Name:JAMES J SARDO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROXANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-796-0338
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0300
Mailing Address - Country:US
Mailing Address - Phone:614-796-0338
Mailing Address - Fax:614-890-5485
Practice Address - Street 1:597 EXECUTIVE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-796-0338
Practice Address - Fax:614-890-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075612261QA1903X, 273Y00000X, 314000000X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2127102Medicaid
OHSA4054282Medicare ID - Type UnspecifiedINDIVIDUAL
OHG30935Medicare UPIN
OH2127102Medicaid