1225493869 NPI number — USA SLEEP DIAGNOSTIC MOBILE SERVICE

Table of content: (NPI 1225493869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225493869 NPI number — USA SLEEP DIAGNOSTIC MOBILE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USA SLEEP DIAGNOSTIC MOBILE SERVICE
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:
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:
1225493869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6030 DAYBREAK CIR
Provider Second Line Business Mailing Address:
SUITE A150 260
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21029-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-792-4445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2929 DAMASCUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-4662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-745-9496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
THURLYN
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
888-792-4445

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  CP-0000085 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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