1053695270 NPI number — ADVANCED CENTER FOR SLEEP DISORDERS

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 1053695270 NPI number — ADVANCED CENTER FOR SLEEP DISORDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CENTER FOR SLEEP DISORDERS
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:
CENTER FOR FAMILY MEDICINE
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:
1053695270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6073 E BRAINERD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-648-8008
Provider Business Mailing Address Fax Number:
706-657-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 WESTSIDE DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-648-8008
Provider Business Practice Location Address Fax Number:
706-657-4400
Provider Enumeration Date:
10/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDRA
Authorized Official First Name:
ANUJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
423-648-8008

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  248184 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: 248184 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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