MEDICARE: SLEEP RESOURCE CONSULTING SERVICE 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	174400000X	Specialist	01398	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265447718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP RESOURCE CONSULTING SERVICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 3267
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-3267
Country	:	US
Telephone Number	:	928-855-7570
Fax Number	:	928-855-7574

Provider Business Practice Location Address
First Line	:	1695 MESQUITE AVE STE 110
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5684
Country	:	US
Telephone Number	:	928-855-7570
Fax Number	:	928-855-7574

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	BRENDA WEVERKA
Credential	:
Telephone Number	:	928-855-7570

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	10/03/2018

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Directions to “SLEEP RESOURCE CONSULTING SERVICE LLC ” Practice Location

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