1073804241 NPI number — SLEEP UNLIMITED JACKSON

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 1073804241 NPI number — SLEEP UNLIMITED JACKSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP UNLIMITED JACKSON
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:
1073804241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
764 WALNUT KNOLL LN
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38018-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-758-2838
Provider Business Mailing Address Fax Number:
901-758-2479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CLINICAL CENTRE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-758-2838
Provider Business Practice Location Address Fax Number:
901-758-2479
Provider Enumeration Date:
04/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EALY
Authorized Official First Name:
ANTHOMY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
901-758-2838

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)