1033172960 NPI number — UNITED SLEEP MEDICINE ASSOCIATES PA

Table of content: (NPI 1033172960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033172960 NPI number — UNITED SLEEP MEDICINE ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED SLEEP MEDICINE ASSOCIATES PA
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:
UNITED SLEEP MEDICINE ASSOCIATES PA
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:
1033172960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5821 FAIRVIEW RD
Provider Second Line Business Mailing Address:
SUITE 415
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-377-5337
Provider Business Mailing Address Fax Number:
704-377-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5821 FAIRVIEW RD
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-3754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-377-5337
Provider Business Practice Location Address Fax Number:
704-377-9992
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REEP
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
STAFF ACCOUNTANT
Authorized Official Telephone Number:
704-927-7300

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 011HV . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89011HV , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011HV . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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