MEDICARE: NORTH ALABAMA SLEEP DISORDER CENTER, 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	261Q00000X	Clinic/Center	11784	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051550480	OTHER	AL	MEDICARE IDTF

General Provider Information

NPI Number	:	1497922009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH ALABAMA SLEEP DISORDER CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 627
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-0627
Country	:	US
Telephone Number	:	256-386-4005
Fax Number	:	256-386-4685

Provider Business Practice Location Address
First Line	:	1111 S RALEIGH AVE
Second Line	:	SUITE 200
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-6350
Country	:	US
Telephone Number	:	256-386-4005
Fax Number	:	256-386-4685

Authorized Official
Title or Position	:	CCO
Name	:	RALPH WILSON
Credential	:
Telephone Number	:	256-386-4005

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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