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General NPI Number Information
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NPI Number | 1750553350
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Entity Type | Organization
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Legal Business Name | WHITE MOUNTAIN SLEEP LAB, INC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 1792 COMMERCE DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-5392
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Country | US
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Telephone | 928-368-3965
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Fax | 928-358-4601
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Provider Business Mailing Address
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Address Line | 1792 COMMERCE DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-5392
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Country | US
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Telephone | 928-368-3965
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Fax | 928-358-4601
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. APRIL R GENTRY
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Credential |
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Telephone | 928-368-3965
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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 | AZ
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