Centrix Medical Management, LLC

Primary specialty

Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X

Legal business name

CENTRIX MEDICAL MANAGEMENT, LLC

Practice address

1135 Kildaire Farm Rd
Suite 200
Cary, NC 27511-7608

Phone

(180) 065-6794

Fax

(187) 722-6707

NPI assigned

Feb 1, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ethan Theophilus, RPSGT

Title

President

Phone

(919) 605-2155

Specialties & licenses 1

Addresses

Other names 1

• C.H.E.S.T Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1811269202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 KILDAIRE FARM RD",
            "address_2": "SUITE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117608",
            "telephone_number": "180-065-6794",
            "fax_number": "187-722-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 KILDAIRE FARM RD",
            "address_2": "SUITE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117608",
            "telephone_number": "180-065-6794",
            "fax_number": "187-722-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRIX MEDICAL MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "THEOPHILUS",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-605-2155",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPSGT"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C.H.E.S.T",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Cary, NC
• Sleep Disorder Diagnostic Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.