Provider Demographics
NPI:1982756219
Name:JP SLEEP DISORDERS LLC
Entity Type:Organization
Organization Name:JP SLEEP DISORDERS LLC
Other - Org Name:JP SLEEP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-728-6145
Mailing Address - Street 1:2661 SE WASHINGTON BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7615
Mailing Address - Country:US
Mailing Address - Phone:918-331-3028
Mailing Address - Fax:
Practice Address - Street 1:2661 SE WASHINGTON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7615
Practice Address - Country:US
Practice Address - Phone:918-331-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115250AMedicaid
OK200115250AMedicaid