Provider Demographics
NPI:1811550569
Name:SAGE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SAGE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-883-1665
Mailing Address - Street 1:4301 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2226
Mailing Address - Country:US
Mailing Address - Phone:484-364-3039
Mailing Address - Fax:610-471-0791
Practice Address - Street 1:4301 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2226
Practice Address - Country:US
Practice Address - Phone:484-364-3039
Practice Address - Fax:610-471-0791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGE MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035381730001Medicaid