=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558623611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP RESOLUTIONS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2012
-----------------------------------------------------
Last Update Date | 06/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1506 TAYLOR PLZ E
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67846-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-271-9400
-----------------------------------------------------
Fax | 620-271-9201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1506 TAYLOR PLZ E
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67846-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-271-9400
-----------------------------------------------------
Fax | 620-271-9201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | CHERI DEROCHIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-260-9789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------