Provider Demographics
NPI:1316998594
Name:SLEEP MED LLC
Entity type:Organization
Organization Name:SLEEP MED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-517-5500
Mailing Address - Street 1:7900 BELFORT PARKWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6978
Mailing Address - Country:US
Mailing Address - Phone:904-517-5500
Mailing Address - Fax:904-517-5501
Practice Address - Street 1:5050 MURPHY CANYON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1847
Practice Address - Country:US
Practice Address - Phone:858-277-7353
Practice Address - Fax:858-514-8626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SLEEP MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIDTF00670Medicaid
CATG575Medicare PIN