MEDICARE: ST JUDE SLEEP SOLUTIONS

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	291U00000X	Clinical Medical Laboratory	RC651	NV

General Provider Information

NPI Number	:	1285938530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JUDE SLEEP SOLUTIONS

Provider Business Mailing Address
First Line	:	6268 S RAINBOW BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3240
Country	:	US
Telephone Number	:	702-818-4008
Fax Number	:	702-818-5446

Provider Business Practice Location Address
First Line	:	6268 S RAINBOW BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3240
Country	:	US
Telephone Number	:	702-818-4008
Fax Number	:	702-818-5446

Authorized Official
Title or Position	:	RESPIRATORY THERAPIST/TECH
Name	:	DYESEBEL GICA ALVARO
Credential	:	CERTIFIED RESPIRATOR
Telephone Number	:	702-885-3371

Provider Enumeration Date	:	12/30/2010
Last Update Date	:	12/30/2010

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