Provider Demographics
NPI:1447891130
Name:SAGE INTERVENTIONAL PAIN MEDICINE
Entity type:Organization
Organization Name:SAGE INTERVENTIONAL PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-366-4900
Mailing Address - Street 1:5651 COVENTRY LN # 128
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7145
Mailing Address - Country:US
Mailing Address - Phone:260-366-4900
Mailing Address - Fax:
Practice Address - Street 1:1169 N MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1362
Practice Address - Country:US
Practice Address - Phone:260-366-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain