Provider Demographics
NPI:1861946790
Name:SAGE CREEK INTEGRATIVE HEALTH LLC
Entity type:Organization
Organization Name:SAGE CREEK INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-455-8255
Mailing Address - Street 1:304 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2804
Mailing Address - Country:US
Mailing Address - Phone:308-455-8255
Mailing Address - Fax:
Practice Address - Street 1:304 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2804
Practice Address - Country:US
Practice Address - Phone:308-455-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty