Healthcare Provider Details

I. General information

NPI: 1588536197
Provider Name (Legal Business Name): SAGE SPINE PAIN AND NERVE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38500 TANGER DR STE 110
NORTH BRANCH MN
55056-5402
US

IV. Provider business mailing address

38500 TANGER DR STE 110
NORTH BRANCH MN
55056-5402
US

V. Phone/Fax

Practice location:
  • Phone: 440-821-7326
  • Fax:
Mailing address:
  • Phone: 651-337-8201
  • Fax: 651-337-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW CLARY
Title or Position: OWNER
Credential: DO
Phone: 440-821-7325