Basic Information
| Provider Information | |||||||||
| NPI: | 1487666095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEPMED INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CHASTAIN BLVD | ||||||||
| Address2: | SUITE 66 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 CORPORATE SQ | ||||||||
| Address2: | SUITE G & H | ||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310214225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007705874 | ||||||||
| FaxNumber: | 4787455125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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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 | 261QS1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic | 207RP1001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2860017 | 01 | AETNA | OTHER | 43490832 | 01 | UNITED HEALTH CARE | OTHER | 905532 | 01 | BLUE CROSS/BLUE SHIELD | OTHER |