Provider Demographics
NPI:1407180144
Name:NEUROCARE SLEEP CENTER
Entity type:Organization
Organization Name:NEUROCARE SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, DBSM
Authorized Official - Phone:330-494-2097
Mailing Address - Street 1:PO BOX 35006
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-5006
Mailing Address - Country:US
Mailing Address - Phone:330-494-2097
Mailing Address - Fax:330-244-2522
Practice Address - Street 1:4105 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-494-2097
Practice Address - Fax:330-244-2522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty