Provider Demographics
NPI:1992114706
Name:MIDLAND SLEEP CENTRAL
Entity type:Organization
Organization Name:MIDLAND SLEEP CENTRAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-355-1601
Mailing Address - Street 1:3668 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2407
Mailing Address - Country:US
Mailing Address - Phone:989-355-1601
Mailing Address - Fax:989-355-1606
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739
Practice Address - Country:US
Practice Address - Phone:989-355-1601
Practice Address - Fax:989-355-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5306004410332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISKM10Medicaid
MI6535080001Medicare NSC