Provider Demographics
NPI:1417015504
Name:CU SLEEPCENTER II
Entity Type:Organization
Organization Name:CU SLEEPCENTER II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:423-764-4429
Mailing Address - Street 1:3915 BRISTOL HWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1400
Mailing Address - Country:US
Mailing Address - Phone:423-283-7533
Mailing Address - Fax:423-283-7532
Practice Address - Street 1:3915 BRISTOL HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1400
Practice Address - Country:US
Practice Address - Phone:423-283-7533
Practice Address - Fax:423-283-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3791387Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER