MEDICARE: NORTHERN COLORADO SLEEP CONSULTANTS, 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	173F00000X	Sleep Specialist (PhD)

General Provider Information

NPI Number	:	1962638940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN COLORADO SLEEP CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	4443 VISTA DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-3330
Country	:	US
Telephone Number	:	970-308-4495
Fax Number	:	970-266-0555

Provider Business Practice Location Address
First Line	:	4443 VISTA DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-3330
Country	:	US
Telephone Number	:	970-308-4495
Fax Number	:	970-266-0555

Authorized Official
Title or Position	:	CHIEF CONSULTANT
Name	:	DR. WILLIAM HERBERT MOORCROFT
Credential	:	PHD
Telephone Number	:	970-308-4495

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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