Provider Demographics
NPI:1407438757
Name:ERIC ALLEN
Entity Type:Organization
Organization Name:ERIC ALLEN
Other - Org Name:SAGE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BREIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-366-9222
Mailing Address - Street 1:27252 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27252 REGAL CT
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8364
Practice Address - Country:US
Practice Address - Phone:605-366-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies