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General NPI Number Information
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NPI Number | 1740902543
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Entity Type | Organization
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Legal Business Name | SAGE SUBSTANCE USE SERVICES
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 7850 JEFFERSON ST NE STE 300
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4314
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Country | US
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Telephone | 505-884-1114
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Fax | 505-884-3004
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Provider Business Mailing Address
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Address Line | 7850 JEFFERSON ST NE STE 300
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4314
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Country | US
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Telephone | 505-884-1114
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Fax | 505-884-3004
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Authorized Official
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Title or Position | CEO
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Name | DR. REUBEN SUTTER
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Credential | MD
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Telephone | 505-884-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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