Healthcare Provider Details

I. General information

NPI: 1689837288
Provider Name (Legal Business Name): NORTHWEST SLEEP CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 HIGHWAY 43 SUITE 13
RUSSELLVILLE AL
35653-4558
US

IV. Provider business mailing address

PO BOX 159
RUSSELLVILLE AL
35653-0159
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-6363
  • Fax:
Mailing address:
  • Phone: 256-332-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ZYNDELL FLEMING
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 256-332-6363