=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801048608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDASLEEP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2008
-----------------------------------------------------
Last Update Date | 10/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19401 SHUMARD OAK DR
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34638-7262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-388-6815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19401 SHUMARD OAK DR
-----------------------------------------------------
City | LAND O LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34638-7262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-388-6815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOHN PIVARCSI JR.
-----------------------------------------------------
Credential | RPSGT, CRT
-----------------------------------------------------
Telephone | 352-428-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number | HCC8284
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------