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
State | License ID | Taxonomies |
---|---|---|
AZ | 261QS1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |