Provider Demographics
NPI:1619798329
Name:SAGE HEALTH CENTER PC
Entity type:Organization
Organization Name:SAGE HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-238-5558
Mailing Address - Street 1:1885 96TH ST E
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55077-4610
Mailing Address - Country:US
Mailing Address - Phone:651-238-5558
Mailing Address - Fax:
Practice Address - Street 1:1440 DUCKWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1451
Practice Address - Country:US
Practice Address - Phone:651-464-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty