Healthcare Provider Details

I. General information

NPI: 1689912214
Provider Name (Legal Business Name): WEST VIRGINIA SLEEP CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MALLARD CT
BECKLEY WV
25801-3664
US

IV. Provider business mailing address

24 MALLARD CT
BECKLEY WV
25801-3664
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-9861
  • Fax:
Mailing address:
  • Phone: 304-253-5420
  • Fax: 681-238-5707

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: MRS. TRACY JOHNSON
Title or Position: OFFICE MANAGER
Credential: LSW
Phone: 304-252-8409