Provider Demographics
NPI:1831248699
Name:SAG VENTURES, INC
Entity type:Organization
Organization Name:SAG VENTURES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARROW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-723-3498
Mailing Address - Street 1:1051 EBER BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8768
Mailing Address - Country:US
Mailing Address - Phone:321-723-3498
Mailing Address - Fax:321-723-2761
Practice Address - Street 1:1051 EBER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8768
Practice Address - Country:US
Practice Address - Phone:321-723-3498
Practice Address - Fax:321-723-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9234Medicare ID - Type UnspecifiedGROUP NUMBER
FL5570170001Medicare NSC