Basic Information
| Provider Information | |||||||||
| NPI: | 1962431528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEPMED THERAPIES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 COBB PLACE BLVD NW | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301443682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008462973 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 COBB PLACE BLVD NW | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705165455 | ||||||||
| FaxNumber: | 6782606702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | NAUFUL | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF COMPLIANCE & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 7703092000 | ||||||||
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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 | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 00885695AB | 05 | GA | MEDICAID | 10059280 | 01 | GA | AMERIGROUP | OTHER | 356411 | 01 | GA | WELLCARE - PIN | OTHER |