MEDICARE: PACIFIC 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	332B00000X	Durable Medical Equipment & Medical Supplies	52918	CA

General Provider Information

NPI Number	:	1689889735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC SLEEP MEDICINE SERVICES, INC

Provider Business Mailing Address
First Line	:	615 W CARMEL DR
Second Line	:	SUITE 100
City	:	CARMEL
State	:	IN
Zip	:	46032-5504
Country	:	US
Telephone Number	:	317-706-1080
Fax Number	:	317-706-1080

Provider Business Practice Location Address
First Line	:	2420 VISTA WAY
Second Line	:	SUITE 115
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-721-7594
Fax Number	:	760-721-9201

Authorized Official
Title or Position	:	PRESIDENT/COO
Name	:	MR. JAY JARRELL
Credential	:
Telephone Number	:	317-706-1080

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/29/2010

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