MEDICARE: PREMIER 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	1223G0001X	General Practice Dentistry
2	332B00000X	Durable Medical Equipment & Medical Supplies

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7090950001	OTHER	UT	MEDICARE

General Provider Information

NPI Number	:	1477284172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER SLEEP LLC

Provider Business Mailing Address
First Line	:	4161 N CRESTVIEW AVE
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-4716
Country	:	US
Telephone Number	:	801-930-5138
Fax Number	:	801-821-2598

Provider Business Practice Location Address
First Line	:	7138 S HIGHLAND DR STE 215
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3784
Country	:	US
Telephone Number	:	801-821-2596
Fax Number	:	801-821-2598

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE MACFARLANE
Credential	:
Telephone Number	:	801-930-5138

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	07/20/2022

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Directions to “PREMIER SLEEP LLC ” Practice Location

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