Provider Demographics
NPI:1013230192
Name:THE ARIZONA CENTER FOR SLEEP MEDICINE
Entity Type:Organization
Organization Name:THE ARIZONA CENTER FOR SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEBNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-471-2761
Mailing Address - Street 1:830 W CALLE ORMINO
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-7833
Mailing Address - Country:US
Mailing Address - Phone:520-471-2761
Mailing Address - Fax:
Practice Address - Street 1:830 W CALLE ORMINO
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-7833
Practice Address - Country:US
Practice Address - Phone:520-471-2761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic