1326211715 NPI number — CLINICAL NEUROPHYSIOLOGY SERVICES, PC

Table of content: (NPI 1326211715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326211715 NPI number — CLINICAL NEUROPHYSIOLOGY SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL NEUROPHYSIOLOGY SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLEEP & ATTENTION DISORDERS INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326211715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44344 DEQUINDRE RD STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48314-1041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-254-0707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44344 DEQUINDRE RD STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48314-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-254-0707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANGAL
Authorized Official First Name:
R
Authorized Official Middle Name:
BART
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
586-254-0707

Provider Taxonomy Codes

  • Taxonomy code: 2084S0012X , with the licence number:  4301046211 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 085738 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130E003300 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130E003300 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1790771 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0E03827 . This is a "BLUE CROSS BLUE SHIELD OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".