Organization
SAGE MEMORIAL HOSPITAL
Active
Other names
SAGE MEMORIAL HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
FARID KIYARASH (DIR OF PHCY)
(928) 755-4500
Entity
Organization
Contact information
Practice address
HWY 264 AND 191, GANADO, AZ 86505
(928) 755-4500
(928) 755-4659
Mailing address
PO BOX 457, GANADO, AZ 86505-0457
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
Y000758
AZ
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021353
—
AZ
01
—
0308949
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/27/2006
Last updated
06/09/2009
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