Basic Information
| Provider Information | |||||||||
| NPI: | 1427346147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID A SACK MD TN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 670521 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752670521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155677282 | ||||||||
| FaxNumber: | 6158072931 | ||||||||
| Practice Location | |||||||||
| Address1: | 6107 PINEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | NUNNELLY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371372523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008495969 | ||||||||
| FaxNumber: | 9317299632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | MAPLESDEN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6155103078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPC, CHC, CHPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | APN0000007899 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | APN0000017055 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 207R00000X | MD0000036454 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363L00000X | APN0000015776 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 2084A0401X | MD21339 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 207Q00000X | MD0000021860 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.