Provider Demographics
NPI:1972692580
Name:SOUTHERN NEVADA SLEEP CLINIC LLC
Entity Type:Organization
Organization Name:SOUTHERN NEVADA SLEEP CLINIC LLC
Other - Org Name:SOUTHERN NEVADA SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-494-6938
Mailing Address - Street 1:920 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:2851 N TENAYA WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0435
Practice Address - Country:US
Practice Address - Phone:702-233-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
V104664Medicare Oscar/Certification