Provider Demographics
NPI:1205031093
Name:KSSRGH SLEEP
Entity Type:Organization
Organization Name:KSSRGH SLEEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-972-1800
Mailing Address - Street 1:10474 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3023
Mailing Address - Country:US
Mailing Address - Phone:623-972-1800
Mailing Address - Fax:623-583-3506
Practice Address - Street 1:10474 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3023
Practice Address - Country:US
Practice Address - Phone:623-972-1800
Practice Address - Fax:623-583-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic