MEDICARE: MOHAVE SLEEP MEDICINE ASSOCIATES 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	23706	AZ

General Provider Information

NPI Number	:	1265541304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAVE SLEEP MEDICINE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 22666
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86439-2666
Country	:	US
Telephone Number	:	928-763-5055
Fax Number	:	928-763-5056

Provider Business Practice Location Address
First Line	:	1520 E HAMMER LN
Second Line	:	SUITE 103
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-788-9445
Fax Number	:	928-763-5056

Authorized Official
Title or Position	:	SUPERVISING PHYSICIAN
Name	:	DR. MUHAMMAD A. NAYER
Credential	:	M.D.
Telephone Number	:	928-763-5055

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/11/2008

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