=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003972431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SNOW SLEEP CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 UNIVERSITY BLVD E STE 707
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-349-4043
-----------------------------------------------------
Fax | 205-758-5132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 UNIVERSITY BLVD E STE 707
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401-7433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-349-4043
-----------------------------------------------------
Fax | 205-758-5132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD M. SNOW
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-349-4043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------