MEDICARE: BEAR SLEEP 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	03378	VA

General Provider Information

NPI Number	:	1194169284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR SLEEP CENTER LLC

Provider Business Mailing Address
First Line	:	2005 OLD GREENBRIER RD
Second Line	:	SUITE NUMBER 106
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2649
Country	:	US
Telephone Number	:	757-962-8538
Fax Number	:	757-962-8598

Provider Business Practice Location Address
First Line	:	2005 OLD GREENBRIER RD
Second Line	:	SUITE NUMBER 106
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2649
Country	:	US
Telephone Number	:	757-962-8538
Fax Number	:	757-962-8598

Authorized Official
Title or Position	:	COO/MANAGING OWNER
Name	:	MR. KEVIN RAY CRUM
Credential	:
Telephone Number	:	757-675-6400

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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