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General NPI Number Information
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NPI Number | 1790032233
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Entity Type | Organization
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Legal Business Name | PHOENIX SLEEP CENTER FOR SNORING & SLEEP APNEA, LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 7505 W DEER VALLEY RD SUITE 120B
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City | PEORIA
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State | AZ
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Zip | 85382-2107
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Country | US
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Telephone | 623-266-0469
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Fax |
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Provider Business Mailing Address
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Address Line | 7505 W DEER VALLEY RD SUITE 120B
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City | PEORIA
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State | AZ
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Zip | 85382-2107
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Country | US
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Telephone | 623-266-0469
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. WILLIAM RANDOL WOMACK
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Credential | DDS
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Telephone | 623-266-0469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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