Healthcare Provider Details

I. General information

NPI: 1083701601
Provider Name (Legal Business Name): SLEEP INSTITUTE OF UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 E RIDGELINE DR STE 104
SOUTH OGDEN UT
84405-4998
US

IV. Provider business mailing address

8706 S 700 E STE 027
SANDY UT
84070-1807
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 DENISE ROBINS
Title or Position: MEMBER MANAGER
Credential: RPSGT
Phone: 801-254-2895