1922020429 NPI number — HENRY COUNTY SLEEP DISORDER CENTER

Table of content: JANET MAY EDMONDSON OTR (NPI 1023130010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922020429 NPI number — HENRY COUNTY SLEEP DISORDER CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY COUNTY SLEEP DISORDER CENTER
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:
1922020429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11600 STATE ROUTE 424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPOLEON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43545-9719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-592-4015
Provider Business Mailing Address Fax Number:
419-591-3850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11600 STATE ROUTE 424
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPOLEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43545-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-592-4015
Provider Business Practice Location Address Fax Number:
419-591-3850
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUGHMANI
Authorized Official First Name:
NAEEM
Authorized Official Middle Name:
AHMED
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
419-471-9757

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: 000000350206 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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