1992834642 NPI number — GAINESVILLE SLEEP LAB, LLC

Table of content: (NPI 1992834642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992834642 NPI number — GAINESVILLE SLEEP LAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAINESVILLE SLEEP LAB, 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:
1992834642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34478-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-732-5552
Provider Business Mailing Address Fax Number:
352-732-1131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 NW 36TH PL
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32606-7348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-732-5552
Provider Business Practice Location Address Fax Number:
352-732-1131
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEMNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMIN DIRECTOR
Authorized Official Telephone Number:
352-732-5552

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: 016061200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: V0398 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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