MEDICARE: CLOUD NINE 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
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134655764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOUD NINE SLEEP & DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	3121 CLEARVIEW CIR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5921
Country	:	US
Telephone Number	:	210-724-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 CLEARVIEW CIR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5921
Country	:	US
Telephone Number	:	210-724-0909
Fax Number	:	713-583-2479

Authorized Official
Title or Position	:	CEO
Name	:	NASSER NOUREDDINE
Credential	:
Telephone Number	:	210-724-0909

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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