Basic Information
| Provider Information | |||||||||
| NPI: | 1174575146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OHIO SLEEP DISORDERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1737 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443091737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883284472 | ||||||||
| FaxNumber: | 3304937123 | ||||||||
| Practice Location | |||||||||
| Address1: | 3985 MEDINA RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442565968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883284472 | ||||||||
| FaxNumber: | 3304937123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3303761902 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 2352109 | 05 | OH | MEDICAID |