=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629495494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGE SPECIALTY CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2014
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 PROSPECT PL NE STE B
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-369-7200
-----------------------------------------------------
Fax | 505-796-6154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7111 PROSPECT PL NE STE B
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-369-7200
-----------------------------------------------------
Fax | 505-796-6154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MARC SOLLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-369-7200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 03287932006
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------