Healthcare Provider Details

I. General information

NPI: 1649262791
Provider Name (Legal Business Name): SABINE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/13/2009
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: 318-256-7543
Mailing address:
  • Phone: 318-226-8202
  • Fax: 318-226-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number539RHC
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number539
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number539
License Number StateLA

VIII. Authorized Official

Name: ROCK BORDELON
Title or Position: CEO
Credential:
Phone: 318-226-8202