1992060776 NPI number — SLEEPMED, INC.

Table of content: (NPI 1992060776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992060776 NPI number — SLEEPMED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEPMED, 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:
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:
1992060776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE PL
Provider Second Line Business Mailing Address:
SUIT 5B
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-334-5085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 N LEE ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
FORSYTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31029-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-334-5085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
IBERGER
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP-CAO
Authorized Official Telephone Number:
800-334-5085

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  19807 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000260246N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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