Basic Information
| Provider Information | |||||||||
| NPI: | 1144401753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP ASSOCIATES OF EAST TENNESSEE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888087 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379958087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706158 | ||||||||
| Practice Location | |||||||||
| Address1: | 7540 DANNAHER WAY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378494013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655457522 | ||||||||
| FaxNumber: | 8655453115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | EISENSTADT | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8655457522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31835302 | 05 | TN | MEDICAID |