Basic Information
| Provider Information | |||||||||
| NPI: | 1194057828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER SLEEP SERVICES, LLC | ||||||||
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| OtherOrganizationName: | PREMIER SLEEP SERVICES-CONCORD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CORPORATE CENTER DR | ||||||||
| Address2: | SUITE #600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002000 | ||||||||
| FaxNumber: | 3055002155 | ||||||||
| Practice Location | |||||||||
| Address1: | 5641 POPLAR TENT RD | ||||||||
| Address2: | SUITE #204 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280277533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042623980 | ||||||||
| FaxNumber: | 7042627593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | BURGOS | ||||||||
| AuthorizedOfficialFirstName: | OFELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3055002114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.