Provider Demographics
NPI:1902085707
Name:SAGE FAMILY HEALTH CENTER LTD CO
Entity Type:Organization
Organization Name:SAGE FAMILY HEALTH CENTER LTD CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-984-1300
Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:G-3
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2143
Mailing Address - Country:US
Mailing Address - Phone:505-984-1300
Mailing Address - Fax:505-986-6447
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:G-3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-984-1300
Practice Address - Fax:505-986-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM011A14OtherBCBS