Provider Demographics
NPI:1649262791
Name:SABINE MEDICAL CENTER INC
Entity type:Organization
Organization Name:SABINE MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:240 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:318-226-8202
Mailing Address - Fax:318-226-8205
Practice Address - Street 1:240 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:318-256-5691
Practice Address - Fax:318-256-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X, 282N00000X
LA539275N00000X, 282NR1301X
LA539RHC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61121OtherBLUE CROSS
LA190078729ZOtherBLUE CROSS PROFESSIONA
LA1760811Medicaid
LA190078728ZOtherBLUE CROSS
LA61121OtherBLUE CROSS
LA19U218Medicare Oscar/Certification
LA193474Medicare Oscar/Certification
LA190078729ZOtherBLUE CROSS PROFESSIONA
LA190078728ZOtherBLUE CROSS