Organization
SAGAMORE SURGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBY ATKINSON BROUILLETTE RN (ADMINISTRATOR DON)
(765) 474-7838
Entity
Organization
Contact information
Practice address
2320 CONCORD RD, STE B, LAFAYETTE, IN 47909-2708
(765) 474-7854
Mailing address
PO BOX 112, MUNCIE, IN 47308-0112
(765) 284-0493
(765) 284-2434
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-006126-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100274550A
—
IN
Enumeration date
07/28/2005
Last updated
04/22/2025
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