Provider Demographics
NPI:1932463676
Name:SLEEP MEDICINE CLINIC
Entity Type:Organization
Organization Name:SLEEP MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-254-2895
Mailing Address - Street 1:5323 S WOODROW ST
Mailing Address - Street 2:STE 205
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5841
Mailing Address - Country:US
Mailing Address - Phone:801-254-2895
Mailing Address - Fax:801-254-4715
Practice Address - Street 1:5323 S WOODROW ST
Practice Address - Street 2:STE 205
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5841
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:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78920080160261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic