Healthcare Provider Details

I. General information

NPI: 1184657983
Provider Name (Legal Business Name): NEOSOM EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9419 COMMON BROOK RD
OWINGS MILLS MD
21117-7536
US

IV. Provider business mailing address

1841 N ROCK ROAD CT SUITE 100
WICHITA KS
67206-4202
US

V. Phone/Fax

Practice location:
  • Phone: 410-902-7141
  • Fax: 410-902-7143
Mailing address:
  • Phone: 316-616-6160
  • Fax: 316-616-6161

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: DUKE C NAIPOHN
Title or Position: OWNER/CEO
Credential:
Phone: 316-683-2323