Basic Information
| Provider Information | |||||||||
| NPI: | 1649262791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SABINE MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | SABINE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182268202 | ||||||||
| FaxNumber: | 3182268205 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182565691 | ||||||||
| FaxNumber: | 3182567543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 04/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | BORDELON | ||||||||
| AuthorizedOfficialFirstName: | ROCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3182268202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | N | Hospital Units | Medicare Defined Swing Bed Unit | 275N00000X | 539 | LA | N | Hospital Units | Medicare Defined Swing Bed Unit | 261QR1300X | 539RHC | LA | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 282NR1301X | 539 | LA | N | Hospitals | General Acute Care Hospital | Rural | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 61121 | 01 | LA | BLUE CROSS | OTHER | 190078729Z | 01 | LA | BLUE CROSS PROFESSIONA | OTHER | 1760811 | 05 | LA | MEDICAID | 190078728Z | 01 | LA | BLUE CROSS | OTHER |