Provider Demographics
NPI:1164140984
Name:SAGESTAR HEALTH & WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:SAGESTAR HEALTH & WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SARAMMA
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC, APRN
Authorized Official - Phone:713-560-1459
Mailing Address - Street 1:4918 BEEKMAN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1209
Mailing Address - Country:US
Mailing Address - Phone:713-560-1459
Mailing Address - Fax:281-972-9242
Practice Address - Street 1:2626 S LOOP W STE 430
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2649
Practice Address - Country:US
Practice Address - Phone:713-560-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care