Provider Demographics
NPI:1164857603
Name:PRIME CARE SLEEP CENTER
Entity Type:Organization
Organization Name:PRIME CARE SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYDARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-408-4476
Mailing Address - Street 1:2200 OPITZ BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3321
Mailing Address - Country:US
Mailing Address - Phone:571-408-4476
Mailing Address - Fax:571-408-4479
Practice Address - Street 1:2200 OPITZ BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3321
Practice Address - Country:US
Practice Address - Phone:571-408-4476
Practice Address - Fax:571-408-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048248261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF42650Medicare UPIN