Basic Information
| Provider Information | |||||||||
| NPI: | 1366603656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN SLEEP MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820014307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086333000 | ||||||||
| FaxNumber: | 3086333001 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820014307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086333000 | ||||||||
| FaxNumber: | 3086333001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | HERMAN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3084367562 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.