Provider Demographics
NPI:1790813590
Name:SLEEP MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SLEEP MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MAHLON
Authorized Official - Last Name:SHOUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-432-5600
Mailing Address - Street 1:112 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4601
Mailing Address - Country:US
Mailing Address - Phone:860-432-5600
Mailing Address - Fax:860-432-5622
Practice Address - Street 1:112 SPENCER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4601
Practice Address - Country:US
Practice Address - Phone:860-432-5600
Practice Address - Fax:860-432-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty