MEDICARE: ADVANCED SLEEP MEDICINE SERVICES INC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HC264A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1629341805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SLEEP MEDICINE SERVICES INC

Provider Business Mailing Address
First Line	:	17835 VENTURA BLVD
Second Line	:	SUITE 300
City	:	ENCINO
State	:	CA
Zip	:	91316-3634
Country	:	US
Telephone Number	:	877-775-3377
Fax Number	:	877-855-6227

Provider Business Practice Location Address
First Line	:	6215 FERRIS SQ
Second Line	:	SUITE 120
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3283
Country	:	US
Telephone Number	:	877-775-3377
Fax Number	:	877-855-6227

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	KERMIT RAY NEWMAN
Credential	:
Telephone Number	:	877-775-3377

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	07/21/2022

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