MEDICARE: NORTHWEST SLEEP CENTER PC

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	:	1689837288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST SLEEP CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-0159
Country	:	US
Telephone Number	:	256-332-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	13150 HIGHWAY 43
Second Line	:	SUITE 13
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-4558
Country	:	US
Telephone Number	:	256-332-6363
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL OFFICER
Name	:	MR. ZYNDELL FLEMING
Credential	:
Telephone Number	:	256-332-6363

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	04/27/2012

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