Healthcare Provider Details

I. General information

NPI: 1245404920
Provider Name (Legal Business Name): SLEEP DX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W. FOREST STREET #B1
BRIGHAM CITY UT
84302
US

IV. Provider business mailing address

515 W. FOREST STREET #B1
BRIGHAM CITY UT
84302
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-0868
  • Fax: 435-723-0861
Mailing address:
  • Phone: 435-723-0868
  • Fax: 435-723-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number69676210160
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBIE KAY MOLGARD
Title or Position: OWNER/OPERATOR
Credential: RPSGT
Phone: 435-723-0868