MEDICARE: FIRST SLEEP 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

General Provider Information

NPI Number	:	1306285507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST SLEEP LLC

Provider Business Mailing Address
First Line	:	PO BOX 862
Second Line	:
City	:	AUBREY
State	:	TX
Zip	:	76227-0862
Country	:	US
Telephone Number	:	940-435-9354
Fax Number	:	866-790-2813

Provider Business Practice Location Address
First Line	:	9304 MASSE CT
Second Line	:
City	:	PROVIDENCE VILLAGE
State	:	TX
Zip	:	76227-5723
Country	:	US
Telephone Number	:	940-435-9354
Fax Number	:	866-790-2813

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. BURLIN LARRY BREWER JR.
Credential	:	B.A., RPSGT, RST
Telephone Number	:	940-435-9354

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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