Provider Demographics
NPI:1154390433
Name:ARIZONA SLEEP INSTITUTE LLC
Entity type:Organization
Organization Name:ARIZONA SLEEP INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-776-8858
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:BLDG E
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-776-8858
Mailing Address - Fax:623-776-1171
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:BLDG E
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-776-8858
Practice Address - Fax:623-776-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79665Medicare ID - Type Unspecified