Healthcare Provider Details

I. General information

NPI: 1316135957
Provider Name (Legal Business Name): SLEEP DIAGNOSTIC CENTERS OF NEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 11/02/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 2ND ST STE 172
ROSWELL NM
88201-2027
US

IV. Provider business mailing address

PO BOX 2055
ROSWELL NM
88202-2055
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-3319
  • Fax: 575-622-1720
Mailing address:
  • Phone: 575-624-2095
  • Fax: 575-627-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIJAY CHECHANI
Title or Position: OWNER
Credential: MD
Phone: 575-624-2095