Provider Demographics
NPI:1902171762
Name:VAMANA, INC.
Entity Type:Organization
Organization Name:VAMANA, INC.
Other - Org Name:SAGE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:870-773-1111
Mailing Address - Street 1:901 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-2889
Mailing Address - Country:US
Mailing Address - Phone:870-773-1111
Mailing Address - Fax:
Practice Address - Street 1:422 BEECH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5310
Practice Address - Country:US
Practice Address - Phone:870-773-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C67850Medicare UPIN