Provider Demographics
NPI:1295824035
Name:SLEEP INSTITUTE OF UTAH LC
Entity Type:Organization
Organization Name:SLEEP INSTITUTE OF UTAH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:801-254-2895
Mailing Address - Street 1:1325 W SOUTH JORDAN PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9060
Mailing Address - Country:US
Mailing Address - Phone:801-254-2895
Mailing Address - Fax:801-254-4715
Practice Address - Street 1:822 E MAIN ST
Practice Address - Street 2:STE 8
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9577
Practice Address - Country:US
Practice Address - Phone:801-884-3290
Practice Address - Fax:801-884-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic