MEDICARE: SLEEP CENTER OF FREMONT, 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	:	1316172216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP CENTER OF FREMONT, LLC.

Provider Business Mailing Address
First Line	:	300 E 23RD ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-2302
Country	:	US
Telephone Number	:	402-727-7768
Fax Number	:	402-727-1864

Provider Business Practice Location Address
First Line	:	300 E 23RD ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-2302
Country	:	US
Telephone Number	:	402-727-7768
Fax Number	:	402-727-1864

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERIC SEITZ
Credential	:
Telephone Number	:	402-727-7768

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	06/22/2009

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