=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104193481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A HOME SLEEP TESTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2011
-----------------------------------------------------
Last Update Date | 11/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1081 280TH ST 7
-----------------------------------------------------
City | JESUP
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50648-9252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-827-2194
-----------------------------------------------------
Fax | 319-827-2037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1081 280TH ST 7
-----------------------------------------------------
City | JESUP
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50648-9252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-827-2194
-----------------------------------------------------
Fax | 319-827-2037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SARAH YOUNGBLUT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-827-2194
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------