Provider Demographics
NPI:1073613923
Name:SLEEP SERVICES OF AMERICA, INC
Entity Type:Organization
Organization Name:SLEEP SERVICES OF AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-5970
Mailing Address - Street 1:430 WOODRUFF RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3495
Mailing Address - Country:US
Mailing Address - Phone:864-527-5970
Mailing Address - Fax:864-527-5971
Practice Address - Street 1:890 AIRPORT PARK RD
Practice Address - Street 2:SUITE 119
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2559
Practice Address - Country:US
Practice Address - Phone:410-760-6990
Practice Address - Fax:410-760-9497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDBRIDGE ACQUISITION CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08228826332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1186230001Medicare NSC