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General NPI Number Information
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NPI Number | 1861936908
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Entity Type | Organization
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Legal Business Name | 1 STOP CPAP SHOP
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 7760 E STATE ROUTE 69 C5-207
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2201
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Country | US
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Telephone | 928-899-6686
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Fax | 877-275-2212
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Provider Business Mailing Address
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Address Line | 7760 E STATE ROUTE 69 C5-207
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2201
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Country | US
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Telephone | 928-899-6686
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Fax | 877-275-2212
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Authorized Official
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Title or Position | CLINICAL SLEEP EDUCATOR
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Name | MR. KORY D JOHNSON
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Credential | RPSGT
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Telephone | 928-899-6686
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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 | 16-00017353
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License Number State | AZ
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