1932146586 NPI number — SUMMIT SLEEP DISORDERS CENTER, LLC

Table of content: (NPI 1932146586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932146586 NPI number — SUMMIT SLEEP DISORDERS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT SLEEP DISORDERS CENTER, 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:
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:
1932146586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1280 SUMMIT DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35501-0102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-387-7900
Provider Business Mailing Address Fax Number:
205-384-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 SUMMIT DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-0104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-387-7900
Provider Business Practice Location Address Fax Number:
205-387-7950
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WESTERMAN
Authorized Official First Name:
JAN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
205-387-7900

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  12828 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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