Provider Demographics
NPI:1578043394
Name:LG SASSER III MD LLC
Entity Type:Organization
Organization Name:LG SASSER III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-430-8503
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-1446
Mailing Address - Country:US
Mailing Address - Phone:479-430-8503
Mailing Address - Fax:479-358-1455
Practice Address - Street 1:1200 FORT ST
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2013
Practice Address - Country:US
Practice Address - Phone:479-763-1511
Practice Address - Fax:479-358-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty