Provider Demographics
NPI:1902228448
Name:SLEEP MEDICINE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SLEEP MEDICINE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:360-421-5953
Mailing Address - Street 1:3298 N GLASSFORD HILL RD
Mailing Address - Street 2:SUITE #104-155
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1294
Mailing Address - Country:US
Mailing Address - Phone:888-759-1112
Mailing Address - Fax:877-275-2212
Practice Address - Street 1:3298 N GLASSFORD HILL RD
Practice Address - Street 2:SUITE #104-155
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1294
Practice Address - Country:US
Practice Address - Phone:888-759-1112
Practice Address - Fax:877-275-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZC000947332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies