Provider Demographics
NPI:1649221656
Name:WILKES BARRE SLEEP SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WILKES BARRE SLEEP SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-208-9070
Mailing Address - Street 1:22 E END CTR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6968
Mailing Address - Country:US
Mailing Address - Phone:570-208-9070
Mailing Address - Fax:570-208-9075
Practice Address - Street 1:22 E END CTR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6968
Practice Address - Country:US
Practice Address - Phone:570-208-9070
Practice Address - Fax:570-208-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1904767OtherBLUE SHIELD
PA1018814760001Medicaid
PA820663OtherFIRST PRIORITY HEALTH
PA7807909OtherAETNA
PA108585Medicare PIN