Provider Demographics
NPI:1023432846
Name:SAGE MEDICINE, LLC
Entity type:Organization
Organization Name:SAGE MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSOM
Authorized Official - Phone:541-708-0642
Mailing Address - Street 1:1012 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2123
Mailing Address - Country:US
Mailing Address - Phone:541-708-0642
Mailing Address - Fax:
Practice Address - Street 1:258 A ST
Practice Address - Street 2:SUITE 20
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:541-708-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC157420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty