Provider Demographics
NPI:1194098384
Name:ADVANCED SLEEP MEDICINE SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCED SLEEP MEDICINE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-479-0500
Mailing Address - Street 1:17835 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:877-775-3377
Mailing Address - Fax:877-855-6227
Practice Address - Street 1:555 WASHINGTON ST
Practice Address - Street 2:SUITE 1037
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2289
Practice Address - Country:US
Practice Address - Phone:310-479-0500
Practice Address - Fax:310-402-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGQ119AMedicare PIN