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	ZZZ13637Z	OTHER	CA	BLUE SHIELD CA
2	7618325	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1932117611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEPMED OF CALIFORNIA INC

Provider Business Mailing Address
First Line	:	200 CORPORATE PL
Second Line	:	SUITE 5B
City	:	PEABODY
State	:	MA
Zip	:	01960-3840
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:	978-535-9757

Provider Business Practice Location Address
First Line	:	72301 COUNTRY CLUB DR
Second Line	:	108
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-8007
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:	978-535-9757

Authorized Official
Title or Position	:	EVP CFO
Name	:	MR. CARL R. IBERGER
Credential	:
Telephone Number	:	978-536-7400

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/15/2010

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