Provider Demographics
NPI:1366689879
Name:PACHIE SABUGA CHAN M.D.P.A
Entity Type:Organization
Organization Name:PACHIE SABUGA CHAN M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PACHIE
Authorized Official - Middle Name:SABUGA
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-271-2227
Mailing Address - Street 1:19073 INTERSTATE 45 S
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8743
Mailing Address - Country:US
Mailing Address - Phone:936-271-2227
Mailing Address - Fax:936-271-2229
Practice Address - Street 1:19073 INTERSTATE 45 S
Practice Address - Street 2:SUITE 115
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8743
Practice Address - Country:US
Practice Address - Phone:936-271-2227
Practice Address - Fax:936-271-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154457901Medicaid
TXG74712Medicare UPIN