1023043866 NPI number — DIAGNOSTIC SLEEP DISORDER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023043866 NPI number — DIAGNOSTIC SLEEP DISORDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC SLEEP DISORDER
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:
1023043866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 EAST VALLEY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-328-1006
Provider Business Practice Location Address Fax Number:
276-628-8246
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINETTE
Authorized Official First Name:
EMORY
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
276-628-1106

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  0101031388 , 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)