Provider Demographics
NPI:1679594857
Name:SLEEP DISORDER CENTERS OF CENTRAL PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:SLEEP DISORDER CENTERS OF CENTRAL PENNSYLVANIA, INC.
Other - Org Name:CLARK AND SHAHINIAN PULMONARY ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-724-2791
Mailing Address - Street 1:2250 MILLENIUM WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1488
Mailing Address - Country:US
Mailing Address - Phone:717-724-2791
Mailing Address - Fax:
Practice Address - Street 1:2250 MILLENIUM WAY
Practice Address - Street 2:STE 400
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025
Practice Address - Country:US
Practice Address - Phone:717-724-2791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50036957OtherCAPITAL BLUE CROSS
245815OtherHEALTH AMERICA
1539407OtherGATEWAY
1587005OtherHIGHMARK
7108552OtherAETNA NON HMO
348850OtherAETNA HMO
1587005OtherHIGHMARK
DB5715Medicare PIN