Provider Demographics
NPI:1992713978
Name:ADVANCE SLEEP DISORDERS CENTER, INC.
Entity type:Organization
Organization Name:ADVANCE SLEEP DISORDERS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KEESAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-0301
Mailing Address - Street 1:6420 DUTCHMANS PARKWAY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-895-0301
Mailing Address - Fax:502-895-0309
Practice Address - Street 1:6420 DUTCHMANS PARKWAY
Practice Address - Street 2:SUITE 190
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-895-0301
Practice Address - Fax:502-895-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
KY730098261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9376701Medicare UPIN