MEDICARE: SABINE MEDICAL CENTER INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	275N00000X	Medicare Defined Swing Bed Hospital Unit
2	275N00000X	Medicare Defined Swing Bed Hospital Unit	539	LA
3	261QR1300X	Rural Health Clinic/Center	539RHC	LA
4	282NR1301X	Rural Acute Care Hospital	539	LA
5	282N00000X	General Acute Care Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61121	OTHER	LA	BLUE CROSS
2	190078729Z	OTHER	LA	BLUE CROSS PROFESSIONA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	190078728Z	OTHER	LA	BLUE CROSS

NPI Number	:	1649262791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SABINE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	240 HIGHLAND DR
Second Line	:
City	:	MANY
State	:	LA
Zip	:	71449-3718
Country	:	US
Telephone Number	:	318-226-8202
Fax Number	:	318-226-8205

Provider Business Practice Location Address
First Line	:	240 HIGHLAND DR
Second Line	:
City	:	MANY
State	:	LA
Zip	:	71449-3718
Country	:	US
Telephone Number	:	318-256-5691
Fax Number	:	318-256-7543

Authorized Official
Title or Position	:	CEO
Name	:	ROCK BORDELON
Credential	:
Telephone Number	:	318-226-8202

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/13/2009

210 HIGHLAND DR
MANY, LA
71449-3718

Practice Phone: 318-256-5722
Practice Fax: 318-256-5774