Healthcare Provider Details

I. General information

NPI: 1770697013
Provider Name (Legal Business Name): E Z SLEEP LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WILLOW CREEK RD
PRESCOTT AZ
86301-1141
US

IV. Provider business mailing address

PO BOX 47729
PHOENIX AZ
85068-7729
US

V. Phone/Fax

Practice location:
  • Phone: 866-397-5337
  • Fax: 928-708-0505
Mailing address:
  • Phone: 623-934-5600
  • Fax: 623-934-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberOTC 3748
License Number StateAZ

VIII. Authorized Official

Name: SATTY BHOWRA
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 602-550-4065