=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194032250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGITA, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 09/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1629 NORTHGATE DR
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34105-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-430-0845
-----------------------------------------------------
Fax | 239-430-0845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1629 NORTHGATE DR
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34105-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-430-0845
-----------------------------------------------------
Fax | 239-430-0845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER-MEMBER
-----------------------------------------------------
Name | DR. JORDAN D SAVOV
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-430-0845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | ME99799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | ME99799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 315D00000X
-----------------------------------------------------
Taxonomy Name | Inpatient Hospice
-----------------------------------------------------
License Number | ME99799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | ME99799
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------