MEDICARE: PREMIER SLEEP LAS VEGAS, 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1760817829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER SLEEP LAS VEGAS, LLC

Provider Business Mailing Address
First Line	:	5031 WAGON TRAIL AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2855
Country	:	US
Telephone Number	:	435-862-2856
Fax Number	:

Provider Business Practice Location Address
First Line	:	5031 WAGON TRAIL AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2854
Country	:	US
Telephone Number	:	435-862-2856
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MANDY PALMER
Credential	:
Telephone Number	:	435-862-2856

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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