Provider Demographics
NPI:1740461656
Name:WASATCH SLEEP HEALTH CENTER, INC
Entity type:Organization
Organization Name:WASATCH SLEEP HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-281-1788
Mailing Address - Street 1:1345 EAST 3900 SOUTH STE 208
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4416
Mailing Address - Country:US
Mailing Address - Phone:801-281-1788
Mailing Address - Fax:801-281-2788
Practice Address - Street 1:1345 EAST 3900 SOUTH STE 208
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4416
Practice Address - Country:US
Practice Address - Phone:801-281-1788
Practice Address - Fax:801-281-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0055977Medicare PIN