1124019849 NPI number — KIRON CLINICAL SLEEP LAB, LLC

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 1124019849 NPI number — KIRON CLINICAL SLEEP LAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRON CLINICAL SLEEP LAB, 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:
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:
1124019849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 N DUKE ST
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-3048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-382-3240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2609 N DUKE ST
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-382-3240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DOYLE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
770-965-0383

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  34166 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3555569 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 89014W6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014W6 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 207009 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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