Healthcare Provider Details

I. General information

NPI: 1205004538
Provider Name (Legal Business Name): ROCKY MOUNTAIN SLEEP DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 300 E
PRICE UT
84501-1811
US

IV. Provider business mailing address

925 N 300 E
PRICE UT
84501-1811
US

V. Phone/Fax

Practice location:
  • Phone: 435-650-6163
  • Fax:
Mailing address:
  • Phone:
  • 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: WAYNE WOODWARD
Title or Position: PRESIDENT/CEO
Credential:
Phone: 435-650-6163