Organization
ADVANCED SLEEP INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL SHELTON (FACILITY MANAGER)
(618) 549-6378
Entity
Organization
Contact information
Practice address
2731 WEST MAIN, SUITE C, CARBONDALE, IL 62901-1000
(618) 519-9999
Mailing address
PO BOX 459, CARBONDALE, IL 62903-0459
(618) 355-9970
(618) 355-9972
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101704
—
IL
Enumeration date
11/27/2012
Last updated
04/16/2013
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