Sage Prairie Laboratory

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Legal business name

SAGE PRAIRIE LABORATORY

Practice address

1440 Duckwood Dr
Eagan, MN 55122-1451

Phone

(651) 238-5558

Fax

(612) 437-4992

NPI assigned

May 22, 2019

Organization subpart

Yes

Parent organization

MEDICAL ADDICTION TREATMENT CLINICAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grant Arnold Pylkas, MMA

Title

Executive Director

Phone

(651) 238-5558

Specialties & licenses 1

Addresses

Other names 1

• Sage Prairie laboratory Doing business as

Electronic endpoints 1

Part of

Medical Addiction Treatment

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Medical Addiction Treatment Clinic

  • Addiction Medicine (Internal Medicine) Physician
  • Minneapolis, MN
  • NPI 1891031209
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1164089447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 DUCKWOOD DR STE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221451",
            "telephone_number": "651-238-5558",
            "fax_number": "612-437-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 DUCKWOOD DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221451",
            "telephone_number": "651-238-5558",
            "fax_number": "612-437-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE PRAIRIE LABORATORY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL ADDICTION TREATMENT CLINIC",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "PYLKAS",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "ARNOLD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-238-5558",
        "authorized_official_credential": "MMA"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spc01@medibillpros.com",
            "affiliation": "N",
            "endpointDescription": "kareo",
            "address_1": "1440 Duckwood Dr",
            "city": "Eagan",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551221451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sage Prairie laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Other Specialist/Technologist in Eagan, MN
• Providers in Eagan, MN by specialty
• Other Specialist/Technologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.