Provider Demographics
NPI:1558077768
Name:SPHERE SD LLC
Entity Type:Organization
Organization Name:SPHERE SD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-267-9994
Mailing Address - Street 1:1303 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-3308
Mailing Address - Country:US
Mailing Address - Phone:858-395-7473
Mailing Address - Fax:
Practice Address - Street 1:10640 SCRIPPS RANCH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1095
Practice Address - Country:US
Practice Address - Phone:858-267-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)