Healthcare Provider Details

I. General information

NPI: 1104237981
Provider Name (Legal Business Name): EBERHART SLEEP DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 N BUTLER AVE SUITE 105
FARMINGTON NM
87401-6425
US

IV. Provider business mailing address

3751 N BUTLER AVE SUITE 105
FARMINGTON NM
87401-6425
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-8379
  • Fax: 949-231-1430
Mailing address:
  • Phone: 505-278-8379
  • Fax: 949-231-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. JOHN C EBERHART
Title or Position: OWNER
Credential: RRT-SDS, RPSGT
Phone: 949-874-5932