Provider Demographics
NPI:1710177167
Name:SABINE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SABINE MEDICAL ASSOCIATES, INC.
Other - Org Name:HUSAM SUKEREK, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:HAIDAR
Authorized Official - Last Name:SUKEREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-256-5722
Mailing Address - Street 1:210 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3718
Mailing Address - Country:US
Mailing Address - Phone:318-256-5722
Mailing Address - Fax:318-256-5774
Practice Address - Street 1:210 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3718
Practice Address - Country:US
Practice Address - Phone:318-256-5722
Practice Address - Fax:318-256-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13676R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436542Medicaid
LAH58852Medicare UPIN