MEDICARE: PHOENIX NEUROLOGY AND SLEEP MEDICINE PLLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1619370707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX NEUROLOGY AND SLEEP MEDICINE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 205112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-5112
Country	:	US
Telephone Number	:	623-535-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 W ROSE GARDEN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3135
Country	:	US
Telephone Number	:	623-535-0050
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	TROY G ANDERSON
Credential	:	MD
Telephone Number	:	623-535-0050

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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