1912080219 NPI number — VITAL SLEEP, LLC

Table of content: (NPI 1912080219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912080219 NPI number — VITAL SLEEP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL SLEEP, 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:
WELLNECESSITIES OF DALLAS
Provider Other Organization Name Type Code:
4
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:
1912080219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8835 LINE AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-222-0885
Provider Business Mailing Address Fax Number:
318-222-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9707 ANDERSON MILL RD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78750-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-222-0885
Provider Business Practice Location Address Fax Number:
318-222-0883
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESMARTEAU
Authorized Official First Name:
LEA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
318-222-0885

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0076806A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3457215 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 531029 . This is a "BCBS DME PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7365296 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PL7071 . This is a "BCBS DX PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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