Provider Demographics
NPI:1922372283
Name:ADVANCED SLEEP MEDICINE SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED SLEEP MEDICINE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-775-3377
Mailing Address - Street 1:17835 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3634
Mailing Address - Country:US
Mailing Address - Phone:877-775-3377
Mailing Address - Fax:877-855-6227
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6788
Practice Address - Country:US
Practice Address - Phone:877-775-3377
Practice Address - Fax:877-855-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGO313AMedicare PIN