Healthcare Provider Details

I. General information

NPI: 1144657008
Provider Name (Legal Business Name): SLEEP MEDICINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EUCALYPTUS AVE BOX 386
CRESCENT CITY FL
32112-2407
US

IV. Provider business mailing address

9838 OLD BAYMEADOWS RD SUITE 386
JACKSONVILLE FL
32256-8101
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-9797
  • Fax: 386-325-9798
Mailing address:
  • Phone: 904-281-1066
  • Fax: 904-281-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. HUBERT ZACHARY
Title or Position: PRESIDENT
Credential: PHD
Phone: 904-281-1066