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General NPI Number Information
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NPI Number | 1548365414
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Entity Type | Organization
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Legal Business Name | SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 3259 N WINDSONG DR SUITE A
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1227
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Country | US
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Telephone | 928-772-6422
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Fax | 928-772-6425
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Provider Business Mailing Address
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Address Line | 3259 N WINDSONG DR STE A
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1222
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Country | US
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Telephone | 928-453-9199
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Fax | 928-453-9207
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MELANIE MUNDELL
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Credential |
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Telephone | 928-453-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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