MEDICARE: SANDMAN SLEEP SERVICES, 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1245608785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDMAN SLEEP SERVICES, LLC

Provider Business Mailing Address
First Line	:	413 MIRADA CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-4512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 MIRADA CT
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-4512
Country	:	US
Telephone Number	:	970-210-5785
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MATT STEELE
Credential	:
Telephone Number	:	970-210-5785

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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