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General NPI Number Information
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NPI Number | 1205968963
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Entity Type | Organization
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Legal Business Name | SUMMIT SLEEP DISORDER CENTER, PA
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 160 CHARLOIS BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1522
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Country | US
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Telephone | 336-768-5834
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Fax | 336-765-4889
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Provider Business Mailing Address
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Address Line | 160 CHARLOIS BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1522
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Country | US
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Telephone | 336-768-5834
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Fax | 336-765-4889
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Authorized Official
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Title or Position | VICE PRESIDENT ADMINISTRATION
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Name | PATRICIA C PULLIAM
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Credential |
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Telephone | 336-768-5834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 19652
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License Number State | NC
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