1760631717 NPI number — ALPHASLEEP LABORATORIES, LLC

Table of content: (NPI 1760631717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760631717 NPI number — ALPHASLEEP LABORATORIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHASLEEP LABORATORIES, 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:
1760631717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12048
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38308-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-660-6199
Provider Business Mailing Address Fax Number:
731-660-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 OLD HUMBOLDT RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-9625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-660-6199
Provider Business Practice Location Address Fax Number:
731-660-8916
Provider Enumeration Date:
09/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
FOUNDING & MANAGING PARTNER
Authorized Official Telephone Number:
731-660-6199

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)

  • Identifier: 1509892 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3550869 . This is a "UNITEDHEALTHCARE / UHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4215319 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3790022 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".