Provider Demographics
NPI:1790032233
Name:PHOENIX SLEEP CENTER FOR SNORING & SLEEP APNEA, LLC
Entity Type:Organization
Organization Name:PHOENIX SLEEP CENTER FOR SNORING & SLEEP APNEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RANDOL
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-266-0469
Mailing Address - Street 1:7505 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 120B
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2107
Mailing Address - Country:US
Mailing Address - Phone:623-266-0469
Mailing Address - Fax:
Practice Address - Street 1:7505 W DEER VALLEY RD
Practice Address - Street 2:SUITE 120B
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2107
Practice Address - Country:US
Practice Address - Phone:623-266-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment