1033646559 NPI number — SOMNILOGIX, LLC

Table of content: (NPI 1033646559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033646559 NPI number — SOMNILOGIX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMNILOGIX, 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:
6
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:
1033646559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SOMNILOGIX, LLC
Provider Second Line Business Mailing Address:
9425 S UNION PARK SQUARE, SUITE 103
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-938-5362
Provider Business Mailing Address Fax Number:
888-972-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOMNILOGIX, LLC
Provider Second Line Business Practice Location Address:
9425 S UNION SQ # 103
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84070-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-790-4599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TREACY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
801-554-5446

Provider Taxonomy Codes

  • Taxonomy code: 207QS1201X , with the licence number:  6149394-8905 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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