Provider Demographics
NPI:1295945319
Name:CHARLESTON SLEEP CENTER PLLC
Entity type:Organization
Organization Name:CHARLESTON SLEEP CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-981-6046
Mailing Address - Street 1:4500 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1806
Mailing Address - Country:US
Mailing Address - Phone:304-981-6046
Mailing Address - Fax:
Practice Address - Street 1:4500 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1806
Practice Address - Country:US
Practice Address - Phone:304-981-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00045261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6804017000Medicaid
CHID01711Medicare ID - Type Unspecified