Healthcare Provider Details

I. General information

NPI: 1497922009
Provider Name (Legal Business Name): NORTH ALABAMA SLEEP DISORDER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S RALEIGH AVE SUITE 200
SHEFFIELD AL
35660-6350
US

IV. Provider business mailing address

PO BOX 627
SHEFFIELD AL
35660-0627
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-4005
  • Fax: 256-386-4685
Mailing address:
  • Phone: 256-386-4005
  • Fax: 256-386-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11784
License Number StateAL

VIII. Authorized Official

Name: RALPH WILSON
Title or Position: CCO
Credential:
Phone: 256-386-4005