Basic Information
| Provider Information | |||||||||
| NPI: | 1700941259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEPMED THERAPIES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | STE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 795 MORNING STAR DR | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953705193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095332545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785366147 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | ZZZ09639Z | 01 | CA | BLUE SHIELD PROVIDER # | OTHER |