Provider Demographics
NPI: | 1790794766 |
---|---|
Name: | SLEEPMED INC. |
Entity Type: | Organization |
Organization Name: | SLEEPMED INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EVP/CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CARL |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | IBERGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 978-536-7400 |
Mailing Address - Street 1: | 200 CORPORATE PL |
Mailing Address - Street 2: | SUITE 5B |
Mailing Address - City: | PEABODY |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01960-3840 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 978-536-7400 |
Mailing Address - Fax: | 978-535-9757 |
Practice Address - Street 1: | 4710 N HABANA AVE |
Practice Address - Street 2: | SUITE 302-A |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33614-7161 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-874-8806 |
Practice Address - Fax: | 813-874-0766 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-07 |
Last Update Date: | 2009-10-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | E4466 | Medicare PIN |