Provider Demographics
NPI:1477720035
Name:SAGE FAMILY MEDICINE
Entity Type:Organization
Organization Name:SAGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/CLINICAL MGR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-566-1915
Mailing Address - Street 1:3451 N BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2357
Mailing Address - Country:US
Mailing Address - Phone:505-566-1915
Mailing Address - Fax:505-566-1918
Practice Address - Street 1:3751 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6435
Practice Address - Country:US
Practice Address - Phone:505-566-1915
Practice Address - Fax:505-566-1918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANCE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty