1861758336 NPI number — SOMNOS LABORATORIES INC

Table of content: (NPI 1861758336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861758336 NPI number — SOMNOS LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMNOS LABORATORIES 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:
SOMNOS SLEEP DISORDERS CENTER
Provider Other Organization Name Type Code:
3
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:
1861758336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 S 70TH ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-4293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-395-0747
Provider Business Mailing Address Fax Number:
308-395-0780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 S LOCUST ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68801-8269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-486-3410
Provider Business Practice Location Address Fax Number:
402-486-3356
Provider Enumeration Date:
04/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STENTZ
Authorized Official First Name:
T
Authorized Official Middle Name:
TROY
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
308-395-0747

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  HC031 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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