1386729234 NPI number — INNOVATIVE SLEEP SOLUTIONS, LLC

Table of content: (NPI 1386729234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386729234 NPI number — INNOVATIVE SLEEP SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SLEEP SOLUTIONS, 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:
1386729234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20403 UNIVERSITY BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-4977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-494-7667
Provider Business Mailing Address Fax Number:
281-494-7668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35670 KENAI SPUR HWY STE 103A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-7649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-262-0829
Provider Business Practice Location Address Fax Number:
907-262-0931
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASP
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
907-262-0829

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: MS 8568 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".