Healthcare Provider Details

I. General information

NPI: 1679627053
Provider Name (Legal Business Name): INNOVATIVE SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BROOKSHIRE LANE
BECKLEY WV
25801
US

IV. Provider business mailing address

PO BOX 981
BECKLEY WV
25802
US

V. Phone/Fax

Practice location:
  • Phone: 304-890-7685
  • Fax:
Mailing address:
  • Phone: 304-890-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CAMDEN J MCLAUGHLIN
Title or Position: PRESIDENT
Credential:
Phone: 540-230-7023