MEDICARE: SMA SLEEP LAB DIAGNOSTIC 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1790039584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMA SLEEP LAB DIAGNOSTIC INC

Provider Business Mailing Address
First Line	:	1408 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8511
Country	:	US
Telephone Number	:	702-333-0350
Fax Number	:	702-333-0351

Provider Business Practice Location Address
First Line	:	1408 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8511
Country	:	US
Telephone Number	:	702-333-0350
Fax Number	:	702-333-0351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VAHAGN AVETISYAN
Credential	:
Telephone Number	:	702-333-0350

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	05/24/2013

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