Provider Demographics
NPI:1588835771
Name:JACK A SASIENE, DPM, PA
Entity Type:Organization
Organization Name:JACK A SASIENE, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SASIENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-948-4848
Mailing Address - Street 1:3200 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6724
Mailing Address - Country:US
Mailing Address - Phone:409-948-4848
Mailing Address - Fax:409-948-6042
Practice Address - Street 1:3200 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6724
Practice Address - Country:US
Practice Address - Phone:409-948-4848
Practice Address - Fax:409-948-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1041500001Medicare NSC