SAGE PRAIRIE LABORATORY (NPI# 1164089447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164089447 |
| Entity Type | Organization |
| Organization Name | SAGE PRAIRIE LABORATORY |
| Practice Address |
1440 Duckwood Dr Eagan MN 55122-1451 |
| Mailing Address |
1440 Duckwood Dr Ste 100 Eagan MN 55122-1451 |
| Practice Telephone | 6512385558 |
| Practice Fax Number | 6124374992 |
| Mailing Telephone | 6512385558 |
| Mailing Fax Number | 6124374992 |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-05-22 |
| Authorized Official Name | GRANT ARNOLD PYLKAS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6512385558 |
| Authorized Official Credential | MMA |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDICAL ADDICTION TREATMENT CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246Z00000X | Specialist/Technologist, Other | Technologists, Technicians & Other Technical Service Providers |
| Other Name | Type Code |
|---|---|
| Sage Prairie laboratory | Doing Business As Name - Organization |
| Street Address |
1440 DUCKWOOD DR |
| City | EAGAN |
| State | MN |
| Zip Code | 55122-1451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376501130 | Karl R Parens | Internal Medicine | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2006-05-02 |
| 1255964458 | Amy Eileen Anderson | Nurse Practitioner | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2020-02-16 |
| 1801391594 | Matveh Panya | Physician Assistant | 1440 Duckwood Dr, Eagan, MN 55122 | 2018-03-26 |
| 1144774456 | Braidy Scott Solie | Physical Therapist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2016-08-04 |
| 1205289899 | Jonathan H Schoenecker | Physical Therapist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2016-07-19 |
| 1891171070 | Heidi Le Andrews | Pharmacist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2015-08-10 |
| 1679977607 | Jenna Brandt | Physical Therapist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2014-10-20 |
| 1508275629 | Amy Herbranson | Pharmacist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2014-08-04 |
| 1073870812 | Christian Antony Dawson | Physical Therapist | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2012-04-18 |
| 1184916280 | Sarah Mcintire | Internal Medicine | 1440 Duckwood Dr, Eagan, MN 55122-1451 | 2011-05-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730651753 | Alvaro Jesus Jimenez Aguilar | Registered Nurse | 1764 Silver Bell Rd, Eagan, MN 55122 | 2019-01-02 |
| 1194213280 | Amherst H. Wilder Foundation | Lodging | Lincoln Place, 1997 Gold Trail, Eagan, MN 55122 | 2018-04-25 |
| 1831541168 | Mackenzie Lea Kerber | Counselor | 3410 Federal Dr Suite 101, Eagan, MN 55122 | 2016-07-11 |
| 1285010074 | Eagan Pointe Senior Living | Assisted Living Facility | 4232 Black Hawk Road, Eagan, MN 55122 | 2015-08-04 |
| 1700268828 | Kara Beth Rose | Specialist/Technologist | 4560 Cinnamon Ridge Trail, Eagan, MN 55122 | 2015-06-25 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| 1528451028 | Judi Ross Holistic Therapy, LLC | Marriage & Family Therapist | 4141 Old Sibley Memorial Highway, Eagan, MN 55122 | 2015-03-09 |
| 1447649637 | Leah Ruth Streitman | Physician Assistant | 3460 Washington Dr Ste 200, Eagan, MN 55122 | 2015-01-12 |
| 1518362193 | Cedar Valley Center for Child & Family Therapy | Preferred Provider Organization | 3460 Washington Dr., Suite 110, Eagan, MN 55122 | 2014-10-25 |
| 1316351703 | Wecare Dental of Eagan P.c | Clinic/Center | 1625 Lena Court Suite 100, Eagan, MN 55122 | 2014-06-13 |
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| Taxonomy Code | 246Z00000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Specialist/Technologist, Other |
| General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093544 | Erica Ann Buchner | Specialist/Technologist, Other | 13397 Europa Ct N Unit 3, Hugo, MN 55038-4497 | 2020-11-08 |
| 1952755506 | Ashley Carlson | Specialist/Technologist, Other | 2125 Granite Dr, Shakopee, MN 55379-2978 | 2016-04-20 |
| 1770974255 | Katie Davis | Specialist/Technologist, Other | 2501 Lakewood Ln, Mound, MN 55364-1608 | 2015-02-05 |
| 1720274830 | Robert Stephen Mccartney | Specialist/Technologist, Other | 3606 Beard Ave N, Robbinsdale, MN 55422-2308 | 2007-09-21 |
| 1982801973 | Sherry Marlene Rovig | Specialist/Technologist, Other | 1982 Lismore Rd, Duluth, MN 55804-3352 | 2007-07-02 |
| 1043336472 | Unity Healthnet | Specialist/Technologist, Other | 4494 Roosevelt Ln Nw, Walker, MN 56484-0000 | 2007-03-21 |
| 1700902962 | Joel M Stokka | Specialist/Technologist, Other | 4494 Roosevelt Lane Nw, Box 833, Walker, MN 56484-0000 | 2007-03-21 |
| 1538224100 | Jessica Jewel Hawley | Specialist/Technologist, Other | 6025 109th Ave N, Champlin, MN 55316-3475 | 2006-12-26 |
| 1376617373 | Tammy Cathleen Long | Specialist/Technologist, Other | 225 Smith Ave North #500, St Paul, MN 55102 | 2006-11-20 |
| 1942390497 | Beverly Elizabeth Bohrer | Specialist/Technologist, Other | 659 Montcalm Pl, Saint Paul, MN 55116-1735 | 2006-10-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.