Organization
RIVER VALLEY SLEEP ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY EDWIN GATELY M.D. (PRESIDENT)
(479) 970-9897
Entity
Organization
Contact information
Practice address
1405 MARINA WAY, RUSSELLVILLE, AR 72802-7951
(479) 880-1884
(479) 880-1884
Mailing address
PO BOX 9035, RUSSELLVILLE, AR 72811-9035
(479) 880-1884
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
C-6606
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13373000001
QUALCHOICE PROVIDER #
AR
05
—
141538002
—
AR
Enumeration date
05/03/2007
Last updated
09/13/2010
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