Provider Demographics
NPI:1609697218
Name:PACIFIC SAGE LLC
Entity type:Organization
Organization Name:PACIFIC SAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTESEN
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP (NP)
Authorized Official - Phone:541-762-2727
Mailing Address - Street 1:2660 NE HIGHWAY 20
Mailing Address - Street 2:SUITE 610 #524
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-762-2727
Mailing Address - Fax:541-645-7243
Practice Address - Street 1:527 NE BELLEVUE DR STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8744
Practice Address - Country:US
Practice Address - Phone:541-640-7243
Practice Address - Fax:541-645-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center