1497148704 NPI number — SLEEP DOCTORS OF MEMPHIS

Table of content: (NPI 1497148704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497148704 NPI number — SLEEP DOCTORS OF MEMPHIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DOCTORS OF MEMPHIS
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:
1497148704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38272
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38183-0272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 CENTERVIEW PKWY
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38018-4227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-752-0662
Provider Business Practice Location Address Fax Number:
901-756-8541
Provider Enumeration Date:
03/11/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREIRE
Authorized Official First Name:
AMADO
Authorized Official Middle Name:
X
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-753-8361

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  31816 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 31816 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 31816 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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