Provider Demographics
NPI:1518026897
Name:WESTERN SLEEP MEDICINE, LLC
Entity Type:Organization
Organization Name:WESTERN SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:308-633-3000
Mailing Address - Street 1:2855 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2202
Mailing Address - Country:US
Mailing Address - Phone:308-633-3000
Mailing Address - Fax:308-633-3001
Practice Address - Street 1:2855 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2202
Practice Address - Country:US
Practice Address - Phone:308-633-3000
Practice Address - Fax:308-633-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026898800Medicaid