Provider Demographics
NPI:1588742084
Name:SLEEP DISORDERS CENTER LLC
Entity type:Organization
Organization Name:SLEEP DISORDERS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-3164
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:ATTENTION: ISADORE RIVAS, SUITE 1200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-962-9303
Mailing Address - Fax:317-962-1095
Practice Address - Street 1:3631 N. MORRISON ROAD
Practice Address - Street 2:MUNCIE MEDICAL ARTS BUILDING, SUITE 101
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:317-962-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic