MEDICARE: PROFESSIONAL SLEEP SERVICES

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1174026785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL SLEEP SERVICES

Provider Business Mailing Address
First Line	:	191 TELLURIDE ST UNIT 5
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4356
Country	:	US
Telephone Number	:	303-396-5923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 S PARKER RD STE 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2163
Country	:	US
Telephone Number	:	303-396-5923
Fax Number	:	303-957-5414

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	JORDAN CAMDEN
Credential	:
Telephone Number	:	303-396-5923

Provider Enumeration Date	:	03/10/2018
Last Update Date	:	03/10/2018

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