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General NPI Number Information
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NPI Number | 1760651681
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Entity Type | Organization
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Legal Business Name | SAGE MEDICAL LABORATORY, LLC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 12/19/2008
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Provider Practice Location Address
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Address Line | 533 N NOVA RD SUITE 202
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4447
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Country | US
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Telephone | 386-944-0826
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Fax | 386-677-6783
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Provider Business Mailing Address
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Address Line | PO BOX 10540
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City | DAYTONA BEACH
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State | FL
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Zip | 32120-0540
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Country | US
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Telephone | 386-944-0826
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Fax | 386-677-6783
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRIS S DANTINI
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Credential |
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Telephone | 386-676-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | FL
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