Healthcare Provider Details

I. General information

NPI: 1235135047
Provider Name (Legal Business Name): MIAMI VALLEY SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980B KINGSGATE RD
SPRINGFIELD OH
45502-8224
US

IV. Provider business mailing address

PO BOX 418
WORTHINGTON OH
43085-0418
US

V. Phone/Fax

Practice location:
  • Phone: 614-433-0614
  • Fax: 866-290-8990
Mailing address:
  • Phone: 614-410-1266
  • Fax: 866-291-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG A PICKERILL
Title or Position: PRESIDENT
Credential: RPSGT
Phone: 614-410-1266