Basic Information
| Provider Information | |||||||||
| NPI: | 1184820151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEPMED HAMPTON ROADS LLC | ||||||||
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| OtherOrganizationName: | SLEEPMED OF HAMPTON ROADS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | SUITE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 154 BURNETTS WAY | ||||||||
| Address2: | SUITE 101-A | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP-CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785367400 | ||||||||
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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 | 2165795 | 01 | VA | MDIPA | OTHER | 344053 | 01 | VA | ANTHEM BCBS | OTHER | 2165795 | 01 | VA | ONENET PPO | OTHER | 419630 | 01 | MD | CARE FIRST | OTHER | 85TZDI | 01 | MD | CARE FIRST | OTHER | 2165795 | 01 | VA | OPTIMUM CHOICE | OTHER | 520537 | 01 | MD | CARE FIRST | OTHER | 552495 | 01 | VA | SOUTHERN HEALTH | OTHER | 8597001 | 01 | VA | CARE FIRST | OTHER | P00600120 | 01 | VA | RAILROAD MEDICARE | OTHER | 8597002 | 01 | VA | CARE FIRST | OTHER | 2165795 | 01 | VA | MAMSI | OTHER |