Healthcare Provider Details

I. General information

NPI: 1710173893
Provider Name (Legal Business Name): SABINE HOSPITALIST PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HIGHLAND DR
MANY LA
71449-3718
US

IV. Provider business mailing address

240 HIGHLAND DR
MANY LA
71449-3718
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5691
  • Fax: 318-256-6539
Mailing address:
  • Phone: 318-256-5691
  • Fax: 318-256-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES RAY PEARSON
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 318-256-5691