Organization
BLUE SAGE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCOUNTS MANAGER)
(702) 453-3799
Entity
Organization
Contact information
Practice address
615 FAIRHURST ST, STERLING, CO 80751-4523
(970) 522-0122
Mailing address
3107 W COLORADO AVE, BOX 291, COLORADO SPRINGS, CO 80904-2088
(702) 453-3799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DR30054726
CO
208M00000X
Hospitalist Physician
Primary
DR30054726
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DR30054726
CO LICENSE
CO
01
—
M12236
ID LICENSE
ID
Enumeration date
05/08/2015
Last updated
05/08/2015
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