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General NPI Number Information
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NPI Number | 1710177167
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Entity Type | Organization
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Legal Business Name | SABINE MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 210 HIGHLAND DR
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City | MANY
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State | LA
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Zip | 71449-3718
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Country | US
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Telephone | 318-256-5722
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Fax | 318-256-5774
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Provider Business Mailing Address
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Address Line | 210 HIGHLAND DR
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City | MANY
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State | LA
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Zip | 71449-3718
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Country | US
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Telephone | 318-256-5722
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Fax | 318-256-5774
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Authorized Official
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Title or Position | PRESIDENT/OFFICER
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Name | DR. HUSAM HAIDAR SUKEREK
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Credential | M.D.
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Telephone | 318-256-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13676R
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License Number State | LA
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