MEDICARE: MAUMELLE SLEEP SOLUTIONS, 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		AR

General Provider Information

NPI Number	:	1215176177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAUMELLE SLEEP SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	9305 TREASURE HILL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-6217
Country	:	US
Telephone Number	:	501-224-5200
Fax Number	:	501-224-5208

Provider Business Practice Location Address
First Line	:	501 MILLWOOD CIR
Second Line	:	SUITE F
City	:	MAUMELLE
State	:	AR
Zip	:	72113-6327
Country	:	US
Telephone Number	:	501-224-5200
Fax Number	:	501-224-5208

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MR. WHITNEY BRENKE
Credential	:	RRT,RPSGT
Telephone Number	:	501-224-5200

Provider Enumeration Date	:	02/16/2009
Last Update Date	:	03/02/2017

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