Healthcare Provider Details

I. General information

NPI: 1063157105
Provider Name (Legal Business Name): SLEEP BETTER IDAHO FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 SARATOGA DR
IDAHO FALLS ID
83404-5109
US

IV. Provider business mailing address

2238 SARATOGA DR
IDAHO FALLS ID
83404-5109
US

V. Phone/Fax

Practice location:
  • Phone: 208-701-2720
  • Fax: 208-701-2939
Mailing address:
  • Phone: 208-701-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK A TALL
Title or Position: OWNER
Credential: DDS
Phone: 208-701-2720