Provider Demographics
NPI:1902145626
Name:1ST CLASS SLEEP DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:1ST CLASS SLEEP DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-281-3553
Mailing Address - Street 1:14631 LEE HWY STE 413
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5835
Mailing Address - Country:US
Mailing Address - Phone:571-281-3553
Mailing Address - Fax:703-373-2671
Practice Address - Street 1:1037 STERLING RD STE 102
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3839
Practice Address - Country:US
Practice Address - Phone:571-281-3553
Practice Address - Fax:703-373-2671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST CLASS SLEEP DIAGNOSTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20122295291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory