Provider Demographics
NPI:1972969368
Name:SAGE ANESTHESIA MANAGEMENT
Entity type:Organization
Organization Name:SAGE ANESTHESIA MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-290-7400
Mailing Address - Street 1:PO BOX 842622
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2622
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:214-301-0649
Practice Address - Street 1:3217 HUNTER LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8826
Practice Address - Country:US
Practice Address - Phone:844-290-7400
Practice Address - Fax:214-301-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty