Healthcare Provider Details

I. General information

NPI: 1972692580
Provider Name (Legal Business Name): SOUTHERN NEVADA SLEEP CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 N TENAYA WAY SUITE 206
LAS VEGAS NV
89128-0435
US

IV. Provider business mailing address

920 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-1731
  • Fax:
Mailing address:
  • Phone: 410-773-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK EHRSAM
Title or Position: MEMBER
Credential:
Phone: 410-494-6938