MEDICARE: SLEEP CENTERS OF FORT WAYNE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RP1001X	Pulmonary Disease Physician
2	2084N0400X	Neurology Physician
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician
4	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1528265709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP CENTERS OF FORT WAYNE LLC

Provider Business Mailing Address
First Line	:	7223 ENGLE RD STE 110
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2239
Country	:	US
Telephone Number	:	260-969-6450
Fax Number	:	260-969-6451

Provider Business Practice Location Address
First Line	:	7223 ENGLE RD STE 110
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2239
Country	:	US
Telephone Number	:	260-969-6450
Fax Number	:	260-969-6451

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN R. SMITH
Credential	:
Telephone Number	:	260-969-6450

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	06/01/2012

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