1740448018 NPI number — SLEEPING BEAR PEDIATRICS PC

Table of content: (NPI 1740448018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740448018 NPI number — SLEEPING BEAR PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEPING BEAR PEDIATRICS 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:
Provider Other Organization Name Type Code:
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:
1740448018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 882470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEAMBOAT SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80488-2470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-879-2327
Provider Business Mailing Address Fax Number:
970-879-1972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 ANGLERS DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-879-2327
Provider Business Practice Location Address Fax Number:
970-879-1972
Provider Enumeration Date:
05/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-879-2327

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  28354 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 98574272 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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