Provider Demographics
NPI:1114979127
Name:SADLER CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:SADLER CLINIC ASSOCIATION
Other - Org Name:SADLER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:936-521-7344
Mailing Address - Street 1:PO BOX 3219
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3219
Mailing Address - Country:US
Mailing Address - Phone:936-760-7900
Mailing Address - Fax:
Practice Address - Street 1:690 S. LOOP 336 WEST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-756-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801Medicaid
TX0667200001Medicare NSC
TX094010801Medicaid
GAC17195Medicare PIN