Provider Demographics
NPI:1235135047
Name:MIAMI VALLEY SLEEP CENTER LLC
Entity Type:Organization
Organization Name:MIAMI VALLEY SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICKERILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:614-410-1266
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-0418
Mailing Address - Country:US
Mailing Address - Phone:614-410-1266
Mailing Address - Fax:866-291-8990
Practice Address - Street 1:1980B KINGSGATE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8224
Practice Address - Country:US
Practice Address - Phone:614-433-0614
Practice Address - Fax:866-290-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2575002Medicaid
OHID02511Medicare PIN
OH2575002Medicaid