Provider Demographics
NPI:1346324944
Name:COMMUNITY SLEEP DISORDERS CENTERS OF AMERICA, INC
Entity Type:Organization
Organization Name:COMMUNITY SLEEP DISORDERS CENTERS OF AMERICA, INC
Other - Org Name:COMMUNITY SLEP DISORDERS CENTERS OF AMERICA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-751-2498
Mailing Address - Street 1:PO BOX 161533
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1533
Mailing Address - Country:US
Mailing Address - Phone:352-751-2498
Mailing Address - Fax:
Practice Address - Street 1:920 ROLLING ACRES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5028
Practice Address - Country:US
Practice Address - Phone:352-751-2498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4739261QS1200X
FL4740261QS1200X
FL4738261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0266Medicare ID - Type Unspecified