1770639379 NPI number — SAGE PROFESSIONAL CONSULTING CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770639379 NPI number — SAGE PROFESSIONAL CONSULTING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGE PROFESSIONAL CONSULTING CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770639379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TWO SAINT MARK'S PL STE 147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-530-8246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TWO SAINT MARK'S PL STE 147
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-530-8246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
CARLTON
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
979-530-8246

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  33121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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