Provider Demographics
NPI:1528261161
Name:SAGEBRUSH E.N.T., INC.
Entity type:Organization
Organization Name:SAGEBRUSH E.N.T., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGSBEE
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-685-1442
Mailing Address - Street 1:1405 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3327
Mailing Address - Country:US
Mailing Address - Phone:307-685-1442
Mailing Address - Fax:
Practice Address - Street 1:1405 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3327
Practice Address - Country:US
Practice Address - Phone:307-685-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X
WY5649A207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY11403101Medicaid
WY15228261161OtherNPI
WYC71195Medicare UPIN
WY15228261161OtherNPI
WYW21454Medicare PIN