Provider Demographics
NPI:1104052281
Name:DR BOB SAGER LLC
Entity type:Organization
Organization Name:DR BOB SAGER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-626-7080
Mailing Address - Street 1:2140 N KANSAS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2012
Mailing Address - Country:US
Mailing Address - Phone:620-626-7080
Mailing Address - Fax:620-626-6633
Practice Address - Street 1:2140 N KANSAS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2012
Practice Address - Country:US
Practice Address - Phone:620-626-7080
Practice Address - Fax:620-626-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26822261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102296Medicare PIN
KSG67595Medicare UPIN