1225275886 NPI number — STEVEN M SACKS MDPA

Table of content: (NPI 1225275886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225275886 NPI number — STEVEN M SACKS MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN M SACKS MDPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225275886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77227-7380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-833-5288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3480 FANNIN ST
Provider Second Line Business Practice Location Address:
STE, I
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-833-5288
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SACKS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MICHEAL
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
409-833-5288

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  J0658 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J0658 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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