Active NPI
Summit Sleep Disorder Center, PA
- Sleep Medicine (Psychiatry & Neurology) Physician
- Winston Salem, NC
National Provider Identifier
1043336951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sleep Medicine (Psychiatry & Neurology) Physician
- License
- 19652
- Legal business name
- SUMMIT SLEEP DISORDER CENTER, PA
- Practice address
- 160 Charlois Blvd
Winston Salem, NC 27103-1522 - Phone
- (336) 768-5834
- Fax
- (336) 765-4889
- NPI assigned
- Mar 22, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Patricia C Pulliam
- Title
- Vice President Administration
- Phone
- (336) 768-5834
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sleep Medicine (Psychiatry & Neurology) Physician | 2084S0012X | 19652 | NC | Primary |
Addresses
Primary practice location
160 Charlois Blvd
Winston Salem, NC 27103-1522
Mailing address
160 Charlois Blvd
Winston Salem, NC 27103-1522
Phone (336) 768-5834
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0764R | Other | NC | BLUE CROSS BLUE SHIELD NC |
National Provider Directory
National Provider Directory- Tax ID family
- Summit Sleep Disorder Center PA
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Winston Salem, NC
- NPI 1295851848
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Winston Salem, NC
- NPI 1952427650
Locations
160 Charlois Blvd
Winston Salem, NC 27103
Phone (336) 768-5834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1043336951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 CHARLOIS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031522",
"telephone_number": "336-768-5834",
"fax_number": "336-765-4889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CHARLOIS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031522",
"telephone_number": "336-768-5834",
"fax_number": "336-765-4889"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUMMIT SLEEP DISORDER CENTER, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-22",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "PULLIAM",
"authorized_official_first_name": "PATRICIA",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "VICE PRESIDENT ADMINISTRATION",
"authorized_official_telephone_number": "336-768-5834"
},
"taxonomies": [
{
"code": "2084S0012X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Sleep Medicine",
"state": "NC",
"license": "19652",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "0764R",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.