1396981460 NPI number — INDIANA REGIONAL SLEEP DISORDER CENTER, 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 1396981460 NPI number — INDIANA REGIONAL SLEEP DISORDER CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA REGIONAL SLEEP DISORDER CENTER, 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:
1396981460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E 86TH AVE
Provider Second Line Business Mailing Address:
PO BOX 10645
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-6382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-1670
Provider Business Mailing Address Fax Number:
219-738-6714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 S WABASH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-944-4187
Provider Business Practice Location Address Fax Number:
219-944-4196
Provider Enumeration Date:
12/19/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
APATA
Authorized Official First Name:
OLUSEGUN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
219-944-4187

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  036-119770 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 036119770 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 036-119770 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036-119770 . This is a "ILLINOIS LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".