Provider Demographics
NPI:1770612236
Name:APPALACHIAN SLEEP DISORDERS CENTER LLC
Entity type:Organization
Organization Name:APPALACHIAN SLEEP DISORDERS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-784-9203
Mailing Address - Street 1:488 S. FLORENCE AVE.
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2378
Mailing Address - Country:US
Mailing Address - Phone:423-784-9203
Mailing Address - Fax:423-784-4647
Practice Address - Street 1:488 S. FLORENCE AVE.
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2378
Practice Address - Country:US
Practice Address - Phone:423-784-9203
Practice Address - Fax:423-784-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26093207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE51026Medicare UPIN
TN3370065Medicare PIN