Healthcare Provider Details

I. General information

NPI: 1679686562
Provider Name (Legal Business Name): SLEEP INSTITUTE OF UTAH LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W SOUTH JORDAN PKWY STE 101
SOUTH JORDAN UT
84095-9060
US

IV. Provider business mailing address

1325 W SOUTH JORDAN PKWY STE 101
SOUTH JORDAN UT
84095-9060
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-2895
  • Fax: 801-254-4715
Mailing address:
  • Phone: 801-254-2895
  • Fax: 801-254-4715

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: MRS. JEANETTE D ROBINS
Title or Position: MEMBER MANAGER
Credential:
Phone: 801-455-8056