Provider Demographics
NPI:1497193460
Name:SAS PRIMARY CARE
Entity Type:Organization
Organization Name:SAS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:UGO
Authorized Official - Last Name:AZUBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MISM
Authorized Official - Phone:972-698-0493
Mailing Address - Street 1:3939 US HIGHWAY 80 E STE 305
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-8110
Mailing Address - Country:US
Mailing Address - Phone:972-698-0493
Mailing Address - Fax:972-698-0844
Practice Address - Street 1:4593 MOUNTAIN LAUREL DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2903
Practice Address - Country:US
Practice Address - Phone:972-698-0493
Practice Address - Fax:972-698-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory