MEDICARE: INTEGRATED SLEEP SOLUTIONS, PC

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	363AM0700X	Medical Physician Assistant	103668	NC

General Provider Information

NPI Number	:	1083888408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED SLEEP SOLUTIONS, PC

Provider Business Mailing Address
First Line	:	5960 FAIRVIEW RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3102
Country	:	US
Telephone Number	:	704-496-2760
Fax Number	:	888-477-0432

Provider Business Practice Location Address
First Line	:	5960 FAIRVIEW RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3102
Country	:	US
Telephone Number	:	704-496-2760
Fax Number	:	888-477-0432

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. ERIC DAVID KIRSCH
Credential	:	PA-C
Telephone Number	:	704-496-2760

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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