Basic Information
| Provider Information | |||||||||
| NPI: | 1477587111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IN YOUR DREAMS INTERNATIONAL INC | ||||||||
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| OtherOrganizationName: | EMERALD COAST SLEEP DISORDERS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 ROSEWOOD DR STE 245 | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019234537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 907 MAR WALT DR | ||||||||
| Address2: | SUITE 2021 | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508630006 | ||||||||
| FaxNumber: | 8508630012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | NAUFUL | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP COMPLIANCE & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 7703092000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | V00E8 | 01 | FL | BCBS OF FLORIDA | OTHER | 94735 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |