Healthcare Provider Details

I. General information

NPI: 1740612498
Provider Name (Legal Business Name): FOUR CORNERS SLEEP SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 EAST MAIN ST SUITE B
FARMINGTON NM
87402
US

IV. Provider business mailing address

6600 EAST MAIN ST SUITE B
FARMINGTON NM
87402
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-6800
  • Fax:
Mailing address:
  • Phone: 505-326-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number4755200
License Number StateNM

VIII. Authorized Official

Name: DR. MICHAEL S TORNOW
Title or Position: OWNER
Credential: DMD
Phone: 505-326-6800