Provider Demographics
NPI:1255503173
Name:TWINKLESCAPE SLEEP DISORDERS CENTER PC
Entity Type:Organization
Organization Name:TWINKLESCAPE SLEEP DISORDERS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-838-7600
Mailing Address - Street 1:9650 STRICKLAND ROAD
Mailing Address - Street 2:SUITE 103-140
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1903
Mailing Address - Country:US
Mailing Address - Phone:919-838-7600
Mailing Address - Fax:919-838-7611
Practice Address - Street 1:935 SHOTWELL ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27549-5597
Practice Address - Country:US
Practice Address - Phone:919-838-7600
Practice Address - Fax:919-838-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00074261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908964Medicaid
DC034110900Medicaid
491338Medicare PIN
H69898Medicare UPIN