MEDICARE: SLEEP DISORDER DIAGNOSTIC CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1023044344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DISORDER DIAGNOSTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	2323 S TROY ST STE 4-100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80014-1982
Country	:	US
Telephone Number	:	303-696-2426
Fax Number	:	303-696-2436

Provider Business Practice Location Address
First Line	:	2323 S TROY ST STE 4-100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80014-1982
Country	:	US
Telephone Number	:	303-696-2426
Fax Number	:	303-696-2436

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ALEXSEY ZHIVOTOV
Credential	:
Telephone Number	:	303-696-2426

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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