Provider Demographics
NPI:1487833091
Name:SARAH HASEK, MD, LLC
Entity Type:Organization
Organization Name:SARAH HASEK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HASEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-351-9559
Mailing Address - Street 1:207 W JACKSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1408
Mailing Address - Country:US
Mailing Address - Phone:618-351-9559
Mailing Address - Fax:618-351-9005
Practice Address - Street 1:207 W JACKSON ST STE 202
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1408
Practice Address - Country:US
Practice Address - Phone:618-351-9559
Practice Address - Fax:618-351-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104069-2Medicaid
IL211544Medicare PIN