Provider Demographics
NPI:1679641351
Name:SLEEP LOGISTIC DIAGNOSTIC CLINIS LTD
Entity Type:Organization
Organization Name:SLEEP LOGISTIC DIAGNOSTIC CLINIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-893-0020
Mailing Address - Street 1:6787 W TROPICANA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4762
Mailing Address - Country:US
Mailing Address - Phone:702-893-0020
Mailing Address - Fax:702-893-0025
Practice Address - Street 1:6787 W TROPICANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4762
Practice Address - Country:US
Practice Address - Phone:702-893-0020
Practice Address - Fax:702-893-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100134Medicare ID - Type Unspecified