Provider Demographics
NPI:1558690313
Name:SLEEPMED PHOENIX, LLC
Entity Type:Organization
Organization Name:SLEEPMED PHOENIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP-CAO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:IBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST
Practice Address - Street 2:SUITE 133
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9142
Practice Address - Country:US
Practice Address - Phone:480-598-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ657353Medicaid
AZP00763325OtherRAILROAD MEDICARE
AZZ136360OtherMEDICARE