Basic Information
| Provider Information | |||||||||
| NPI: | 1255367413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEPMED THERAPIES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CHASTAIN CENTER BLVD NW | ||||||||
| Address2: | SUITE 66 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301445598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008462973 | ||||||||
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| Practice Location | |||||||||
| Address1: | 123 CAPCOM AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275876517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195709715 | ||||||||
| FaxNumber: | 9195709483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 77004916 | 05 | NC | MEDICAID |