1023009594 NPI number — SLEEP ASSOCIATES LLC

Table of content: (NPI 1023009594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023009594 NPI number — SLEEP ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP ASSOCIATES LLC
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:
THE SLEEP CLINIC
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:
1023009594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16125 N MAY AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-8979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-767-6970
Provider Business Mailing Address Fax Number:
405-879-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16125 N MAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-8978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-767-6970
Provider Business Practice Location Address Fax Number:
405-879-1949
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNELL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
405-767-6970

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: 100748750A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470001228 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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