Healthcare Provider Details

I. General information

NPI: 1295785087
Provider Name (Legal Business Name): ED EVERETT HILLIS RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 CARTHAGE ST
SANFORD NC
27330-4206
US

IV. Provider business mailing address

345 CARTHAGE ST
SANFORD NC
27330-4206
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-0512
  • Fax: 919-776-0517
Mailing address:
  • Phone: 919-776-0512
  • Fax: 919-776-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number4188
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: