=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356352124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP DIAGNOSTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 02/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 N MONTANA AVE SUITE A9
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-3845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-449-8999
-----------------------------------------------------
Fax | 406-449-8989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 N MONTANA AVE SUITE A9
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-3845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-449-8999
-----------------------------------------------------
Fax | 406-449-8989
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | SHELLEY JEAN SCHIAVON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-449-8999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------