MEDICARE: SLEEP DISORDER CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1053445163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DISORDER CENTERS, INC

Provider Business Mailing Address
First Line	:	PO BOX 5576
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-5576
Country	:	US
Telephone Number	:	405-600-1950
Fax Number	:	405-600-1949

Provider Business Practice Location Address
First Line	:	3613 NW 56TH ST
Second Line	:	SUITE 380
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4526
Country	:	US
Telephone Number	:	405-600-1950
Fax Number	:	405-600-1949

Authorized Official
Title or Position	:	INSURANCE CONTRACTING SPECIALIST
Name	:	SHELLI M WALL
Credential	:
Telephone Number	:	405-600-1950

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	06/16/2009

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