1942216601 NPI number — SLEEP TELEMEDICINE SERVICES, INC

Table of content: (NPI 1942216601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942216601 NPI number — SLEEP TELEMEDICINE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP TELEMEDICINE SERVICES, INC
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:
1942216601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 W TERRELL AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-657-1920
Provider Business Mailing Address Fax Number:
817-820-0430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 W TERRELL AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-657-1920
Provider Business Practice Location Address Fax Number:
817-820-0430
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
ANN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
800-657-1920

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00452376 . This is a "RR MEDICARE KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00995634 . This is a "RR MEDICARE KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01268066 . This is a "RR MEDICARE FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P01273982 . This is a "RR MEDICARE NV" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: P00098084 . This is a "RR MEDICARE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2369093 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000936300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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