Provider Demographics
NPI:1508069287
Name:SLEEP MEDICINE CENTER INC.
Entity Type:Organization
Organization Name:SLEEP MEDICINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:M (MIKE)
Authorized Official - Last Name:ZACHARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:904-281-1066
Mailing Address - Street 1:9838 OLD BAYMEADOWS RD
Mailing Address - Street 2:BOX 386
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-281-1066
Mailing Address - Fax:904-281-1060
Practice Address - Street 1:310 S PALM AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4179
Practice Address - Country:US
Practice Address - Phone:386-325-9797
Practice Address - Fax:386-325-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RS0012X
2472E0500X
FL6698261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2254OtherBLUE CROSS BLUE SHIELD
FLV2254OtherBLUE CROSS BLUE SHIELD
FLV2254OtherBLUE CROSS BLUE SHIELD