Provider Demographics
NPI:1164644308
Name:RIVER VALLEY SLEEP ASSOCIATES, INC
Entity Type:Organization
Organization Name:RIVER VALLEY SLEEP ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-970-9897
Mailing Address - Street 1:PO BOX 9035
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9035
Mailing Address - Country:US
Mailing Address - Phone:479-880-1884
Mailing Address - Fax:
Practice Address - Street 1:1405 MARINA WAY
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-7951
Practice Address - Country:US
Practice Address - Phone:479-880-1884
Practice Address - Fax:479-880-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6606207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141538002Medicaid
AR13373000001OtherQUALCHOICE PROVIDER #
AR13373000001OtherQUALCHOICE PROVIDER #
ARD04470Medicare UPIN