Basic Information
| Provider Information | |||||||||
| NPI: | 1508059601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OHIO SLEEP DISORDERS CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 W EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761902 | ||||||||
| FaxNumber: | 3303760482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK WEST BLVD | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443204218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761902 | ||||||||
| FaxNumber: | 3303760482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAFECAS | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3303761902 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OHIO SLEEP DISORDERS CENTERS | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | 1002292 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.