Provider Demographics
NPI:1124204433
Name:CLOUD PEAK SLEEP SPECIALIST LLC
Entity Type:Organization
Organization Name:CLOUD PEAK SLEEP SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-673-6300
Mailing Address - Street 1:1050 MYDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2186
Mailing Address - Country:US
Mailing Address - Phone:307-673-6300
Mailing Address - Fax:
Practice Address - Street 1:1050 MYDLAND RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2186
Practice Address - Country:US
Practice Address - Phone:307-673-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6950A2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty