Provider Demographics
NPI:1790469047
Name:SANUSOM PC
Entity Type:Organization
Organization Name:SANUSOM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EMMET
Authorized Official - Last Name:SEIBELS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:615-668-9039
Mailing Address - Street 1:10 CADILLAC DR STE 350
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5095
Mailing Address - Country:US
Mailing Address - Phone:615-668-9039
Mailing Address - Fax:
Practice Address - Street 1:1570 THE ALAMEDA STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2331
Practice Address - Country:US
Practice Address - Phone:844-398-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty