Organization
SAGE MEMORIAL HOSPITAL
Active
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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