Provider Demographics
NPI:1003697087
Name:MOUNTAIN SAGE MEDICINE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN SAGE MEDICINE, LLC
Other - Org Name:MOUNTAIN SAGE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SILAPIE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:509-808-6364
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0548
Mailing Address - Country:US
Mailing Address - Phone:509-808-6364
Mailing Address - Fax:888-612-3925
Practice Address - Street 1:107 W JEWETT BLVD STE 700
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-8974
Practice Address - Country:US
Practice Address - Phone:509-808-6364
Practice Address - Fax:888-612-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty