Provider Demographics
NPI:1609584614
Name:SAGE ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:SAGE ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:304-638-0295
Mailing Address - Street 1:5818 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8813
Mailing Address - Country:US
Mailing Address - Phone:304-638-0295
Mailing Address - Fax:681-238-5016
Practice Address - Street 1:58 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:304-252-4900
Practice Address - Fax:304-252-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty