Basic Information
| Provider Information | |||||||||
| NPI: | 1760512412 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SLEEPMED HAMPTON ROADS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIOSERENITY | ||||||||
| 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: | 9785359778 | ||||||||
| Practice Location | |||||||||
| Address1: | 2713 NEIL ARMSTRONG PKWY STE G1 | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236661572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572244200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHOCK | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP CLINICAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2145323757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 85TZDI | 01 | MD | CARE FIRST | OTHER | 2165795 | 01 | VA | MDIPA | OTHER | 2165795 | 01 | VA | ONENET PPO | OTHER | 419630 | 01 | MD | CARE FIRST | OTHER | 8597001 | 01 | VA | CARE FIRST | OTHER | 2165795 | 01 | VA | MAMSI | OTHER | 2165795 | 01 | VA | OPTIMUM CHOICE | OTHER | 304515 | 01 | VA | ANTHEM BCBS | OTHER | 1760512412 | 05 | VA | MEDICAID | 520537 | 01 | MD | CARE FIRST | OTHER | 552495 | 01 | VA | SOUTHERN HEALTH | OTHER | 8597002 | 01 | VA | CARE FIRST | OTHER | P00600120 | 01 | VA | RAILROAD MEDICARE | OTHER |