MEDICARE: SOMNOGRAPH, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1740492495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMNOGRAPH, INC

Provider Business Mailing Address
First Line	:	1841 N ROCK ROAD CT STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-4202
Country	:	US
Telephone Number	:	316-683-2323
Fax Number	:	316-683-1778

Provider Business Practice Location Address
First Line	:	1841 N ROCK ROAD CT STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-4202
Country	:	US
Telephone Number	:	316-683-2323
Fax Number	:	316-683-1778

Authorized Official
Title or Position	:	ACCOUNTING
Name	:	RYAN BLASDEL
Credential	:
Telephone Number	:	316-683-2323

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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