=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013474303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND SLEEP MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2019
-----------------------------------------------------
Last Update Date | 02/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 E 4500 S STE 110
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-685-3225
-----------------------------------------------------
Fax | 801-210-7067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8941 S 700 E STE 204
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-290-0992
-----------------------------------------------------
Fax | 801-210-7067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | KIAYA CHRISTINE KILPACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 385-290-0992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------