Provider Demographics
NPI:1508925264
Name:SAGE SYSTEMS INC
Entity Type:Organization
Organization Name:SAGE SYSTEMS INC
Other - Org Name:SAGE MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:E
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HECKLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-615-9049
Mailing Address - Street 1:1400 HAND AVENUE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-615-9049
Mailing Address - Fax:386-615-2027
Practice Address - Street 1:1400 HAND AVENUE
Practice Address - Street 2:SUITE L
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-615-9049
Practice Address - Fax:386-615-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9022OtherBCBS
FLL9022OtherBCBS