1467406009 NPI number — SLEEP DISORDERS CENTER OF LONDON & CORBIN, PLLC

Table of content: (NPI 1467406009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467406009 NPI number — SLEEP DISORDERS CENTER OF LONDON & CORBIN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DISORDERS CENTER OF LONDON & CORBIN, PLLC
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:
6
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:
1467406009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3121 WALL ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40513-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-223-9990
Provider Business Mailing Address Fax Number:
859-219-9454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 OFFICE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42501-4151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-451-0781
Provider Business Practice Location Address Fax Number:
606-451-0791
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
606-451-0781

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  730105 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00138970 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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