=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073271722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. BERNARD GUY SAGE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2021
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7278 DORSET ST.
-----------------------------------------------------
City | SHELBURNE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-233-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7278 DORSET ST.
-----------------------------------------------------
City | SHELBURNE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-233-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 063-0000131
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------