Provider Demographics
NPI:1861936908
Name:1 STOP CPAP SHOP
Entity type:Organization
Organization Name:1 STOP CPAP SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SLEEP EDUCATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:928-899-6686
Mailing Address - Street 1:7760 E STATE ROUTE 69
Mailing Address - Street 2:C5-207
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2201
Mailing Address - Country:US
Mailing Address - Phone:928-899-6686
Mailing Address - Fax:877-275-2212
Practice Address - Street 1:7760 E STATE ROUTE 69
Practice Address - Street 2:C5-207
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2201
Practice Address - Country:US
Practice Address - Phone:928-899-6686
Practice Address - Fax:877-275-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-00017353261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic