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General NPI Number Information
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NPI Number | 1164644308
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY SLEEP ASSOCIATES, INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 1405 MARINA WAY
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-7951
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Country | US
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Telephone | 479-880-1884
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Fax | 479-880-1884
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Provider Business Mailing Address
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Address Line | PO BOX 9035
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9035
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Country | US
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Telephone | 479-880-1884
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY EDWIN GATELY
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Credential | M.D.
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Telephone | 479-970-9897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | C-6606
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License Number State | AR
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