1306808043 NPI number — JOHN L SAGER MD

Table of content: JOHN L SAGER MD (NPI 1306808043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306808043 NPI number — JOHN L SAGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAGER
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306808043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 E. BARNETT ROAD
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-789-8176
Provider Business Mailing Address Fax Number:
541-789-2558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 N. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-5853
Provider Business Practice Location Address Fax Number:
541-482-5124
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD17878 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD17878 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 057492 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97520A012 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023713000 . This is a "BLUE CROSS BLUE SHIELD OF OREGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930086138 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023507000 . This is a "BC/BS OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 930091706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: F60655 . This is a "PROVIDENCE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: F60655 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: XPY191030 . This is a "MEDI CAL" identifier . This identifiers is of the category "OTHER".




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