Basic Information
Provider Information | |||||||||
NPI: | 1235358763 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SLEEPMED THERAPIES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 60 CHASTAIN CENTER BLVD NW | ||||||||
Address2: | SUITE 66 | ||||||||
City: | KENNESAW | ||||||||
State: | GA | ||||||||
PostalCode: | 301445598 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7705925544 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3299 WOODBURN RD | ||||||||
Address2: | SUITE 250-C | ||||||||
City: | ANNANDALE | ||||||||
State: | VA | ||||||||
PostalCode: | 220031275 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7038769870 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2007 | ||||||||
LastUpdateDate: | 05/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ROSE | ||||||||
AuthorizedOfficialFirstName: | JOSEPH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP OF FINANCE & ADMINISTRATION | ||||||||
AuthorizedOfficialTelephone: | 9785367400 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 117758 | 01 | VA | SOUTHERN HEALTH | OTHER | 2168698 | 01 | VA | MDIPA | OTHER | 2168698 | 01 | VA | MAMSI | OTHER | 8201299 | 01 | VA | AMERICHOICE | OTHER | 2168698 | 01 | VA | ONENET PPO | OTHER | 2168698 | 01 | VA | OPTIMUM CHOICE | OTHER |