Basic Information
| Provider Information | |||||||||
| NPI: | 1972692580 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN NEVADA SLEEP CLINIC LLC | ||||||||
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| OtherOrganizationName: | SOUTHERN NEVADA SLEEP CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 RIDGEBROOK RD | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211529390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107731000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2851 N TENAYA WAY | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022331731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | EHRSAM | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4104946938 | ||||||||
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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.