MEDICARE: UNIVERSITY SLEEP MEDICINE LLC

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	332900000X	Non-Pharmacy Dispensing Site	35086201	OH

General Provider Information

NPI Number	:	1053832279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY SLEEP MEDICINE LLC

Provider Business Mailing Address
First Line	:	9039 ANTARES AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-4067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9039 ANTARES AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-4067
Country	:	US
Telephone Number	:	614-854-0300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ESKENDER GETACHEW
Credential	:
Telephone Number	:	614-854-0300

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	06/28/2017

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