Provider Demographics
NPI:1033285226
Name:SLEEPMED OF CALIFORNIA
Entity Type:Organization
Organization Name:SLEEPMED OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-933-0422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06439ZOtherBLUE SHIELD CA
CATG108DMedicare ID - Type UnspecifiedMEDICARE CA