Provider Demographics
NPI:1164131579
Name:SAJE MEDICAL CONCIERGE SERVICES OF DALLAS LLC
Entity Type:Organization
Organization Name:SAJE MEDICAL CONCIERGE SERVICES OF DALLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:816-651-6774
Mailing Address - Street 1:213 WARBLER DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 E AIRPORT FWY STE 260
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6332
Practice Address - Country:US
Practice Address - Phone:816-651-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center