Provider Demographics
NPI:1881334605
Name:SAGE MOUNTAIN HEALTH
Entity type:Organization
Organization Name:SAGE MOUNTAIN HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUTOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-299-2944
Mailing Address - Street 1:1341 HARRISON AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4801
Mailing Address - Country:US
Mailing Address - Phone:406-299-2944
Mailing Address - Fax:
Practice Address - Street 1:1341 HARRISON AVE STE 15
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4801
Practice Address - Country:US
Practice Address - Phone:406-249-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty