Provider Demographics
NPI:1225264112
Name:SLEEP MANAGEMENT INSTITUTE LLC
Entity Type:Organization
Organization Name:SLEEP MANAGEMENT INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOELZHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-759-6164
Mailing Address - Street 1:3157 VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1876
Mailing Address - Country:US
Mailing Address - Phone:812-481-1780
Mailing Address - Fax:812-481-1786
Practice Address - Street 1:3157 VILLA WAY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1876
Practice Address - Country:US
Practice Address - Phone:812-481-1780
Practice Address - Fax:812-481-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058606A207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200833360AMedicaid
IN000000598539OtherANTHEM PIN
IN200833360AMedicaid