Provider Demographics
NPI:1588536197
Name:SAGE SPINE PAIN AND NERVE CENTER
Entity type:Organization
Organization Name:SAGE SPINE PAIN AND NERVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-821-7325
Mailing Address - Street 1:38500 TANGER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5402
Mailing Address - Country:US
Mailing Address - Phone:440-821-7326
Mailing Address - Fax:
Practice Address - Street 1:38500 TANGER DR STE 110
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5402
Practice Address - Country:US
Practice Address - Phone:440-821-7326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty