MEDICARE: SLEEP SERVICE CENTER LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1669723425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP SERVICE CENTER LLC

Provider Business Mailing Address
First Line	:	11220 W LAPHAM ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-3806
Country	:	US
Telephone Number	:	414-282-5451
Fax Number	:	414-282-5467

Provider Business Practice Location Address
First Line	:	11220 W LAPHAM ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-3806
Country	:	US
Telephone Number	:	414-282-5451
Fax Number	:	414-282-5467

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DOUGLAS KERSTETTER
Credential	:
Telephone Number	:	414-282-5451

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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