1356482764 NPI number — ADVANCED SLEEP DIAGNOSTICS, INC.

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 1356482764 NPI number — ADVANCED SLEEP DIAGNOSTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SLEEP DIAGNOSTICS, 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:
6
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:
1356482764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 W BOCKMAN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38583-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-836-8492
Provider Business Mailing Address Fax Number:
931-836-3633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
439 W BOCKMAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38583-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-836-8492
Provider Business Practice Location Address Fax Number:
931-836-3633
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZURAWEK
Authorized Official First Name:
TOMASZ
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
931-836-8492

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  28804 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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