Provider Demographics
NPI:1679836134
Name:SAGE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:SAGE MEDICAL GROUP PLLC
Other - Org Name:SAGEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-681-9310
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:425-681-9310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGE MEDICAL GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site