Provider Demographics
NPI:1932146586
Name:SUMMIT SLEEP DISORDERS CENTER, LLC
Entity Type:Organization
Organization Name:SUMMIT SLEEP DISORDERS CENTER, LLC
Other - Org Name:THE REST OF YOUR LIFE SLEEP EVALUATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-387-7900
Mailing Address - Street 1:1280 SUMMIT DR.
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-0102
Mailing Address - Country:US
Mailing Address - Phone:205-387-7900
Mailing Address - Fax:205-384-9006
Practice Address - Street 1:1350 SUMMIT DR.
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-0104
Practice Address - Country:US
Practice Address - Phone:205-387-7900
Practice Address - Fax:205-387-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12828261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557579Medicare PIN