1710179262 NPI number — CENTRAL VIRGINIA SLEEP DISORDERS CENTER, PLLC

Table of content: (NPI 1710179262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710179262 NPI number — CENTRAL VIRGINIA SLEEP DISORDERS CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VIRGINIA SLEEP DISORDERS CENTER, PLLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1710179262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 ROLLING HILLS DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-282-5555
Provider Business Mailing Address Fax Number:
804-270-7840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 ROLLING HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-282-5555
Provider Business Practice Location Address Fax Number:
804-270-7840
Provider Enumeration Date:
08/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARTSOOK
Authorized Official First Name:
ROY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PH.D., NURSE PRACTITIONER
Authorized Official Telephone Number:
804-270-6811

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  S1609496 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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