MEDICARE: KSSRGH SLEEP

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	:	1205031093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KSSRGH SLEEP

Provider Business Mailing Address
First Line	:	10474 W THUNDERBIRD BLVD
Second Line	:	SUITE 200
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3023
Country	:	US
Telephone Number	:	623-972-1800
Fax Number	:	623-583-3506

Provider Business Practice Location Address
First Line	:	10474 W THUNDERBIRD BLVD
Second Line	:	SUITE 200
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3023
Country	:	US
Telephone Number	:	623-972-1800
Fax Number	:	623-583-3506

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JATIN SHAH
Credential	:	M.D.
Telephone Number	:	623-972-1800

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/22/2020

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