| Sage Psychiatry Services Llc | |
|
1002 Rumsey Ave Ste A Cody WY 82414-3533 | |
| (307) 395-7510 | |
| (307) 395-7511 |
| Full Name | Sage Psychiatry Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1002 Rumsey Ave Ste A, Cody, Wyoming |
| Authorized Official Name and Position | Krista L Blough (OWNER) |
| Authorized Official Contact | 3073957510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sage Psychiatry Services Llc 1002 Rumsey Ave Ste A Cody WY 82414-3533 Ph: (307) 395-7510 | Sage Psychiatry Services Llc 1002 Rumsey Ave Ste A Cody WY 82414-3533 Ph: (307) 395-7510 |
| NPI Number | 1700665577 |
|---|---|
| Provider Enumeration Date | 09/21/2023 |
| Last Update Date | 01/11/2024 |
| Certification Date | 01/11/2024 |
| Medicare PECOS PAC ID | 7517498793 |
|---|---|
| Medicare Enrollment ID | O20240927002626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700665577 | NPI | - | NPPES |
| 1447491188 | Other | INDIVIDUAL NPI | |
| 1669740858 | Other | INDIVIDUAL NPI | |
| 1538432513 | Other | INDIVIDUAL NPI | |
| 1851366314 | Other | INDIVIDUAL NPI |
| Provider Name | Krista Lee Blough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538432513 PECOS PAC ID: 4284885591 Enrollment ID: I20121114000653 |
| Provider Name | Scott E Pollard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851366314 PECOS PAC ID: 8426002858 Enrollment ID: I20130829000897 |
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