MEDICARE: SLEEPMED OF CALIFORNIA, 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
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7618325	OTHER	CA	AETNA
2	ZZZ06438Z	OTHER	CA	BLUE SHIELD CA

General Provider Information

NPI Number	:	1851410864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEPMED OF CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	99 ROSEWOOD DR STE 245
Second Line	:
City	:	DANVERS
State	:	MA
Zip	:	01923-4537
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:	978-535-9778

Provider Business Practice Location Address
First Line	:	105 N HILL AVE STE 206
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1934
Country	:	US
Telephone Number	:	626-449-3033
Fax Number	:

Authorized Official
Title or Position	:	EVP CLINICAL OPERATIONS
Name	:	JANICE SHOCK
Credential	:
Telephone Number	:	214-532-3757

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	05/10/2022

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