1619174208 NPI number — SLEEP SOLUTIONS OF NEW IBERIA, LLC

Table of content: (NPI 1619174208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619174208 NPI number — SLEEP SOLUTIONS OF NEW IBERIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP SOLUTIONS OF NEW IBERIA, LLC
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:
1619174208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2309 EAST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70560-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-364-8500
Provider Business Mailing Address Fax Number:
337-364-8582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 ANDRE ST STE 200B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-606-0041
Provider Business Practice Location Address Fax Number:
337-606-0047
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
337-364-8500

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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