Provider Demographics
NPI:1972077063
Name:SABINE VALLEY MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:SABINE VALLEY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PICKLE KRISPIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:903-450-0710
Mailing Address - Street 1:4702 WESLEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5663
Mailing Address - Country:US
Mailing Address - Phone:214-683-7481
Mailing Address - Fax:214-722-6996
Practice Address - Street 1:4702 WESLEY ST STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5663
Practice Address - Country:US
Practice Address - Phone:214-683-7481
Practice Address - Fax:214-722-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty