MEDICARE: 1ST CLASS SLEEP DIAGNOSTICS, 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	107828	VA

General Provider Information

NPI Number	:	1881938090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CLASS SLEEP DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	14631 LEE HWY
Second Line	:	SUITE 413
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-5824
Country	:	US
Telephone Number	:	703-385-9222
Fax Number	:	703-373-2671

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR
Second Line	:	SUITE 305
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3258
Country	:	US
Telephone Number	:	703-385-9222
Fax Number	:	703-373-2671

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YOUNG YI
Credential	:
Telephone Number	:	703-385-9222

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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