Provider Demographics
NPI:1487747176
Name:ROCKY MOUNTAIN SLEEP DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN SLEEP DIAGNOSTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-343-2222
Mailing Address - Street 1:640 FLORMANN ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4600
Mailing Address - Country:US
Mailing Address - Phone:605-343-2222
Mailing Address - Fax:605-343-2227
Practice Address - Street 1:640 FLORMANN ST
Practice Address - Street 2:SUITE 145
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4600
Practice Address - Country:US
Practice Address - Phone:605-343-2222
Practice Address - Fax:605-343-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS100245Medicare PIN