Healthcare Provider Details

I. General information

NPI: 1306371737
Provider Name (Legal Business Name): VIRGINIA SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROCK POINTE LN
WARRENTON VA
20186-2630
US

IV. Provider business mailing address

60 ROCK POINTE LN
WARRENTON VA
20186-2630
US

V. Phone/Fax

Practice location:
  • Phone: 540-628-2175
  • Fax:
Mailing address:
  • Phone: 540-628-2175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006730
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0401006730
License Number StateVA

VIII. Authorized Official

Name: JAMES JELINEK JR.
Title or Position: OWNER
Credential:
Phone: 540-628-2175