MEDICARE: SOUTHERN NEVADA SLEEP CLINIC 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1972692580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA SLEEP CLINIC LLC

Provider Business Mailing Address
First Line	:	920 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9390
Country	:	US
Telephone Number	:	410-773-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 N TENAYA WAY
Second Line	:	SUITE 206
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0435
Country	:	US
Telephone Number	:	702-233-1731
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	FREDERICK EHRSAM
Credential	:
Telephone Number	:	410-494-6938

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/16/2012

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