Provider Demographics
NPI:1821492968
Name:ADVANCED SLEEP SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED SLEEP SOLUTIONS
Other - Org Name:ADVANCED SLEEP SOLUTIONS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-418-9167
Mailing Address - Street 1:2183 W MAIN ST STE A208
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6762
Mailing Address - Country:US
Mailing Address - Phone:801-418-9167
Mailing Address - Fax:801-701-2114
Practice Address - Street 1:2183 W MAIN ST STE A208
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6762
Practice Address - Country:US
Practice Address - Phone:801-418-9167
Practice Address - Fax:801-701-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870281028000Medicaid
UT000059100Medicare PIN
UT870281028000Medicaid