1548365414 NPI number — SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC

Table of content: (NPI 1548365414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548365414 NPI number — SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLEEP DISORDERS OF FLAGSTAFF LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548365414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3259 N WINDSONG DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-453-9199
Provider Business Mailing Address Fax Number:
928-453-9207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3259 N WINDSONG DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-772-6422
Provider Business Practice Location Address Fax Number:
928-772-6425
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUNDELL
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
928-453-9199

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC9826 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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