MEDICARE: DREAM AWAY SLEEP LAB

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	:	1659572907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM AWAY SLEEP LAB

Provider Business Mailing Address
First Line	:	3326 ASPEN GROVE DR
Second Line	:	SUITE 260
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2837
Country	:	US
Telephone Number	:	615-790-9401
Fax Number	:	615-790-8688

Provider Business Practice Location Address
First Line	:	3326 ASPEN GROVE DR
Second Line	:	SUITE 260
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2837
Country	:	US
Telephone Number	:	615-790-9401
Fax Number	:	615-790-8688

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDREW R EARL
Credential	:
Telephone Number	:	615-790-9401

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/13/2008

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