Organization · Type 2 NPI

Sage Prairie Laboratory

Other Specialist/Technologist · Eagan, MN

NPI number 1164089447 Active

Practice location

1440 Duckwood Dr
Eagan, MN 55122-1451

Call (651) 238-5558 Map

Fax (612) 437-4992

Mailing address

1440 Duckwood Dr Ste 100
Eagan, MN 55122-1451

Specialties and licenses

Taxonomy	Code	License
Other Specialist/Technologist Primary	246Z00000X	None listed

Other Specialist/Technologist: General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines.

29 other providers at this address

NPI record

NPI: 1164089447
Entity type: Organization (Type 2)
Issued: May 22, 2019
Last updated: May 22, 2019
Status: Active
Subpart: Yes of Medical Addiction Treatment Clinic

Other names

Sage Prairie Laboratory · doing business as

Authorized official

Grant Arnold Pylkas, MMA
Executive Director
(651) 238-5558

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1164089447

Sage Prairie Laboratory's National Provider Identifier is 1164089447, issued on May 22, 2019. The primary taxonomy on file is Other Specialist/Technologist (246Z00000X), and the practice location is in Eagan, MN. The record was last updated on May 22, 2019.