1861532608 NPI number — SLEEP MEDICINE ASSOCIATES, LLC.

Table of content: (NPI 1861532608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861532608 NPI number — SLEEP MEDICINE ASSOCIATES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP MEDICINE ASSOCIATES, 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:
1861532608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1433
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHYSBORO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-993-0086
Provider Business Mailing Address Fax Number:
608-993-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8305 EXPRESS DRIVE, SUITE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-993-0086
Provider Business Practice Location Address Fax Number:
618-993-0088
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
618-993-0086

Provider Taxonomy Codes

  • Taxonomy code: 2084S0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 660328 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036109663 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0723320 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3932015 . This is a "BLUECROSS BLUESHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DF5180 . This is a "RAILROAD MEDICARE- GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 088817 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00118900 . This is a "RAILROAD MEDICARE- PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 208084 . This is a "MEDICARE- GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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