Provider Demographics
NPI:1528255866
Name:SARAH L. AGSTEN DO, LLC
Entity type:Organization
Organization Name:SARAH L. AGSTEN DO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AGSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-673-5225
Mailing Address - Street 1:2508 NW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6220
Mailing Address - Country:US
Mailing Address - Phone:541-673-5225
Mailing Address - Fax:541-673-5781
Practice Address - Street 1:2508 NW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5510
Practice Address - Country:US
Practice Address - Phone:541-673-5225
Practice Address - Fax:541-229-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG66251Medicare UPIN
ORR113024Medicare PIN