Healthcare Provider Details

I. General information

NPI: 1457781213
Provider Name (Legal Business Name): SLEEP MEDICINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 BAYMEADOWS CIR SUITE 111
JACKSONVILLE FL
32256-1880
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 904-281-1066
  • Fax: 904-281-1060
Mailing address:
  • Phone: 904-281-1066
  • Fax: 904-281-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

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