Provider Demographics
NPI:1164552642
Name:COMMONWEALTH SLEEP AND REHAB, PLLC
Entity Type:Organization
Organization Name:COMMONWEALTH SLEEP AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:CROMWELL
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:859-264-1815
Mailing Address - Street 1:120 PROSPEROUS PL STE 102
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1866
Mailing Address - Country:US
Mailing Address - Phone:859-264-1815
Mailing Address - Fax:859-264-1820
Practice Address - Street 1:120 PROSPEROUS PL STE 102
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1866
Practice Address - Country:US
Practice Address - Phone:859-264-1815
Practice Address - Fax:859-264-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 207RS0012X, 208100000X, 207L00000X
KYPA817363A00000X
KY3006792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65946139Medicaid
KY7100194690Medicaid
KY7100335460Medicaid