Provider Demographics
NPI:1649593377
Name:STULTZ SLEEP STUDY SERVICES
Entity Type:Organization
Organization Name:STULTZ SLEEP STUDY SERVICES
Other - Org Name:REST ENSURED SLEEP TECHNOLOGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-638-6163
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0457
Mailing Address - Country:US
Mailing Address - Phone:304-733-5380
Mailing Address - Fax:304-733-5796
Practice Address - Street 1:6171 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1227
Practice Address - Country:US
Practice Address - Phone:304-733-5380
Practice Address - Fax:304-733-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV166722084P0800X, 2084P0804X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346244936OtherMHNET
1346249836OtherCIGNA BEHAVIORAL HEALTH
1346249836OtherMSBCBS
1346249836OtherUNITED BEHAVIORAL HEALTH
1346249836OtherHEALTHNET/TRICARE
1346249836OtherHUMANA
1346244936OtherWELLS FARGO (PEIA)
1346249836Other4-MOST
4510542OtherAETNA
WV3810018469Medicaid
1346249836OtherCARELINK/COVENTRY
1346249836OtherHUMANA
WVF17637Medicare UPIN