Provider Demographics
NPI:1316344153
Name:REJUV SAVAGE MANAGEMENT, LLC
Entity type:Organization
Organization Name:REJUV SAVAGE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPCO
Authorized Official - Phone:320-352-8475
Mailing Address - Street 1:7373 FRANCE AVE S STE 606
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4552
Mailing Address - Country:US
Mailing Address - Phone:952-777-3899
Mailing Address - Fax:
Practice Address - Street 1:7373 FRANCE AVE S STE 606
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4552
Practice Address - Country:US
Practice Address - Phone:952-777-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REJUV MEDICAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080012605Medicaid
MN64886800OtherDMERC
MNH38658Medicare UPIN