Healthcare Provider Details

I. General information

NPI: 1023043866
Provider Name (Legal Business Name): DIAGNOSTIC SLEEP DISORDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 MAIN STREET
WISE VA
24293
US

IV. Provider business mailing address

320 EAST VALLEY STREET
ABINGDON VA
24210
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-1006
  • Fax: 276-628-8246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number0101031388
License Number StateVA

VIII. Authorized Official

Name: EMORY ROBINETTE
Title or Position: DOCTOR
Credential:
Phone: 276-628-1106