MEDICARE: LONGMONT SLEEP DIAGNOSTICS INC

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1073878484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGMONT SLEEP DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	364 N DE GAULLE CT
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80018-1580
Country	:	US
Telephone Number	:	303-396-2992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 DRY CREEK DR
Second Line	:	SUITE 303
City	:	LONGMONT
State	:	CO
Zip	:	80503-7731
Country	:	US
Telephone Number	:	303-396-2992
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MONICA ROBB
Credential	:
Telephone Number	:	303-396-2992

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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