Provider Demographics
NPI:1265533590
Name:SLEEP DIAGNOSTICS OF UTAH, INC.
Entity type:Organization
Organization Name:SLEEP DIAGNOSTICS OF UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSH AKA DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-298-2191
Mailing Address - Street 1:425 MEDICAL DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4942
Mailing Address - Country:US
Mailing Address - Phone:801-298-2191
Mailing Address - Fax:801-298-2373
Practice Address - Street 1:425 MEDICAL DR STE 208
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4942
Practice Address - Country:US
Practice Address - Phone:801-298-2191
Practice Address - Fax:801-298-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5846816-0142291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT30147200500001OtherBLUE CROSS BLUE SHIELD
UT=========840100OtherTRICARE PROFESSIONAL