MEDICARE: SLEEP HEALTH WISCONSIN 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	122300000X	Dentist
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1821811423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP HEALTH WISCONSIN LLC

Provider Business Mailing Address
First Line	:	1052 BEL AIRE CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5015
Country	:	US
Telephone Number	:	920-499-2121
Fax Number	:	844-965-9312

Provider Business Practice Location Address
First Line	:	2805 LIBAL ST STE B
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2888
Country	:	US
Telephone Number	:	920-339-9013
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL CLINIC COORDINATOR
Name	:	TRACY ADAMS
Credential	:
Telephone Number	:	920-425-4140

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/12/2024

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