Provider Demographics
NPI:1548365414
Name:SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC
Entity type:Organization
Organization Name:SLEEP DISORDER CENTER OF PRESCOTT VALLEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-453-9199
Mailing Address - Street 1:3259 N WINDSONG DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1222
Mailing Address - Country:US
Mailing Address - Phone:928-453-9199
Mailing Address - Fax:928-453-9207
Practice Address - Street 1:3259 N WINDSONG DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1227
Practice Address - Country:US
Practice Address - Phone:928-772-6422
Practice Address - Fax:928-772-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC9826OtherRAILROAD MEDICARE
AZZ102495Medicare ID - Type Unspecified
AZDC9826OtherRAILROAD MEDICARE