MEDICARE: NO WAKE ZONE

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	:	1508198029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NO WAKE ZONE

Provider Business Mailing Address
First Line	:	4133 PERIDOT DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 PERIDOT DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5807
Country	:	US
Telephone Number	:	757-286-8030
Fax Number	:

Authorized Official
Title or Position	:	TECHNICAL DIRECTOR
Name	:	CORY ARNOLD
Credential	:
Telephone Number	:	757-286-8030

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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Directions to “NO WAKE ZONE ” Practice Location

Language	Start Address	Practice Location

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