Provider Demographics
NPI:1568954709
Name:SAGE WOMEN'S IMAGING AND SPECIALTY ULTRASOUND, P.C.
Entity Type:Organization
Organization Name:SAGE WOMEN'S IMAGING AND SPECIALTY ULTRASOUND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-851-9395
Mailing Address - Street 1:404 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6168
Mailing Address - Country:US
Mailing Address - Phone:541-851-9395
Mailing Address - Fax:
Practice Address - Street 1:404 S 4TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6168
Practice Address - Country:US
Practice Address - Phone:541-851-9395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1871892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty