Provider Demographics
NPI:1679686562
Name:SLEEP INSTITUTE OF UTAH LC
Entity Type:Organization
Organization Name:SLEEP INSTITUTE OF UTAH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-455-8056
Mailing Address - Street 1:1325 W SOUTH JORDAN PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9060
Mailing Address - Country:US
Mailing Address - Phone:801-254-2895
Mailing Address - Fax:801-254-4715
Practice Address - Street 1:1325 W SOUTH JORDAN PKWY
Practice Address - Street 2:STE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9060
Practice Address - Country:US
Practice Address - Phone:801-254-2895
Practice Address - Fax:801-254-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic