NPIMap

Sage Medical Group LLC

Organization Active NPI Clinical Medical Laboratory · Casper, WY

NPI 1164561528 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1164561528
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
Legal business name
SAGE MEDICAL GROUP LLC
Practice address
419 S Washington Street
Suite 201
Casper, WY 82601
Phone
(307) 265-8300
Fax
(307) 265-8313
NPI assigned
Feb 5, 2007
Organization subpart
No

Authorized official

Name
Mr. Charles D Moses
Title
Chief Administrative Officer
Phone
(307) 265-8300

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D2308448Casper Medical Imaging / Wiva
419 South Washington Suite 101, Casper, WY 82601		ComplianceDec 2, 2026

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X WY Yes

Addresses

Primary practice location

419 S Washington Street
Suite 201
Casper, WY 82601

Mailing address

PO Box 50750
Casper, WY 82605
Phone (307) 265-8300

Other names

  • Sage Medical Group Laboratory Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164561528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50750",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "82605",
            "telephone_number": "307-265-8300",
            "fax_number": "307-265-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S WASHINGTON STREET",
            "address_2": "SUITE 201",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "82601",
            "telephone_number": "307-265-8300",
            "fax_number": "307-265-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOSES",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "307-265-8300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sage Medical Group Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Casper, WY

All providers in Casper, WY · Clinical Medical Laboratory in Wyoming

Sources for this page

Verify at the official NPI Registry.