Provider Demographics
NPI:1407866239
Name:SLEEP DISORDERS OF PALM SPRINGS
Entity Type:Organization
Organization Name:SLEEP DISORDERS OF PALM SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:760-778-1320
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-1311
Mailing Address - Country:US
Mailing Address - Phone:760-778-1320
Mailing Address - Fax:760-778-1360
Practice Address - Street 1:1330 N INDIAN CANYON DR STE H
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-778-1320
Practice Address - Fax:760-778-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02787ZMedicare PIN
CA6048800001Medicare NSC