Organization
SAGE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA COOPER (ADMINISTRATIVE SERVICES MANAGER)
(307) 265-8300
Entity
Organization
Contact information
Practice address
419 S WASHINGTON ST, STE 200, CASPER, WY 82601
(307) 265-8300
(307) 265-8313
Mailing address
PO BOX 50750, CASPER, WY 82605
(307) 265-8300
(307) 265-8313
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1221190600
—
WY
Enumeration date
03/09/2006
Last updated
10/11/2007
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