1700118445 NPI number — PROFESSIONAL SLEEP DIAGNOSTICS, INC

Table of content: (NPI 1700118445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700118445 NPI number — PROFESSIONAL SLEEP DIAGNOSTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL SLEEP DIAGNOSTICS, INC
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:
1700118445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 CORPORATE CENTER DR
Provider Second Line Business Mailing Address:
SUITE #600
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-500-2000
Provider Business Mailing Address Fax Number:
305-500-2155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5897 COUNTY ROAD 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROCTORVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45669-8852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-319-0202
Provider Business Practice Location Address Fax Number:
304-254-8802
Provider Enumeration Date:
02/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARGER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-486-2620

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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