Organization
SLEEP MANAGEMENT INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE M GOELZHAUSER (OFFICE MANAGER)
(812) 759-6164
Entity
Organization
Contact information
Practice address
3157 VILLA WAY, JASPER, IN 47546-1876
(812) 481-1780
(812) 481-1786
Mailing address
3157 VILLA WAY, JASPER, IN 47546-1876
(812) 481-1780
(812) 481-1786
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
01058606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000598539
ANTHEM PIN
IN
05
—
200833360A
—
IN
Enumeration date
06/05/2009
Last updated
08/03/2009
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