SAGE HEALTHCARE PLLC

Provider Demographics

• NPI: 1891820767
• Name: SAGE HEALTHCARE PLLC
• Entity Type: Organization
• Organization Name: SAGE HEALTHCARE PLLC
• Authorized Official - Title/Position: CREDENTIALER
• Authorized Official - First Name: CHERI
• Authorized Official - Last Name: PETERSON
• Authorized Official - Phone: 208-954-5594
• Mailing Address - Street 1: 413 N ALLUMBAUGH ST
• Mailing Address - Street 2: STE 101
• Mailing Address - City: BOISE
• Mailing Address - State: ID
• Mailing Address - Zip Code: 83704-9212
• Mailing Address - Country: US
• Mailing Address - Phone: 208-323-1125
• Mailing Address - Fax: 208-323-9604
• Practice Address - Street 1: 413 N ALLUMBAUGH ST
• Practice Address - Street 2: STE 101
• Practice Address - City: BOISE
• Practice Address - State: ID
• Practice Address - Zip Code: 83704-9212
• Practice Address - Country: US
• Practice Address - Phone: 208-323-1125
• Practice Address - Fax: 208-323-9604
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-22
• Last Update Date: 2021-04-20

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ID	807468900	Medicaid
ID	1374272	Medicare ID - Type Unspecified
ID	1374272	Medicare PIN