1326276262 NPI number — SLEEP DISORDERS CENTER OF PRESCOTT VALLEY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326276262 NPI number — SLEEP DISORDERS CENTER OF PRESCOTT VALLEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DISORDERS 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:
Provider Other Organization Name Type Code:
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:
1326276262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE HAVASU CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86405-3270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-453-9199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 MESQUITE AVE STE B
Provider Second Line Business Practice Location Address:
LAKE HAVASU CITY
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-5771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-453-9199
Provider Business Practice Location Address Fax Number:
928-453-9207
Provider Enumeration Date:
06/30/2009

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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