Provider Demographics
NPI:1194031161
Name:PRINCETON SLEEP MEDICINE, LLC
Entity Type:Organization
Organization Name:PRINCETON SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-967-6142
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:POB I; SUITE 332
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-781-3752
Mailing Address - Fax:205-788-7244
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:POB I; SUITE 332
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-781-3752
Practice Address - Fax:205-788-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1194031161/122048Medicaid
AL102G705895Medicare PIN