Provider Demographics
NPI:1689804379
Name:BEHAVIOR AND SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:BEHAVIOR AND SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-434-4611
Mailing Address - Street 1:880 VINTAGE LAKE COURT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4088
Mailing Address - Country:US
Mailing Address - Phone:937-885-7556
Mailing Address - Fax:937-384-4826
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE ROAD
Practice Address - Street 2:SLEEP LAB
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-885-7556
Practice Address - Fax:937-384-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-036352207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0521537Medicaid
OH0521537Medicaid
OHRU0395464Medicare PIN