Healthcare Provider Details

I. General information

NPI: 1164552642
Provider Name (Legal Business Name): COMMONWEALTH SLEEP AND REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROSPEROUS PL STE 102
LEXINGTON KY
40509-1866
US

IV. Provider business mailing address

120 PROSPEROUS PL STE 102
LEXINGTON KY
40509-1866
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-1815
  • Fax: 859-264-1820
Mailing address:
  • Phone: 859-264-1815
  • Fax: 859-264-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA817
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006792
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: OLIVER CROMWELL JAMES II
Title or Position: PRESIDENT/ OWNER
Credential: M.D.
Phone: 859-264-1815