Provider Demographics
NPI:1427346147
Name:DAVID A SACK MD TN PC
Entity type:Organization
Organization Name:DAVID A SACK MD TN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHC, CHPC
Authorized Official - Phone:615-510-3078
Mailing Address - Street 1:PO BOX 670521
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-0521
Mailing Address - Country:US
Mailing Address - Phone:615-567-7282
Mailing Address - Fax:615-807-2931
Practice Address - Street 1:6107 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:NUNNELLY
Practice Address - State:TN
Practice Address - Zip Code:37137-2523
Practice Address - Country:US
Practice Address - Phone:800-849-5969
Practice Address - Fax:931-729-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021860207Q00000X
TNMD0000036454207R00000X
TNMD213392084A0401X
TNAPN0000015776363L00000X
TNAPN0000007899363LP0808X
TNAPN0000017055363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty