Provider Demographics
NPI:1093828790
Name:SLEEP MANAGEMENT INSTITUTE LLC
Entity Type:Organization
Organization Name:SLEEP MANAGEMENT INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-721-1986
Mailing Address - Street 1:3157 VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546
Mailing Address - Country:US
Mailing Address - Phone:513-527-3471
Mailing Address - Fax:513-721-1649
Practice Address - Street 1:3157 VILLA WAY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:513-527-3471
Practice Address - Fax:513-721-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061490A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200833360AMedicaid
INDG9056Medicare PIN
INP00634182Medicare PIN
IN200833360AMedicaid