Provider Demographics
NPI:1104377613
Name:DAVID A SACK MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID A SACK MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:ELEMENTS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR RCM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CHC,CHPC
Authorized Official - Phone:615-540-3708
Mailing Address - Street 1:PO BOX 671387
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1387
Mailing Address - Country:US
Mailing Address - Phone:615-567-7282
Mailing Address - Fax:615-261-8912
Practice Address - Street 1:20786 COOL OAK WAY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5318
Practice Address - Country:US
Practice Address - Phone:424-235-2337
Practice Address - Fax:310-943-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
CA20A134162084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty