# OMNISLEEP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508093469
- **Authorized official:** MR. JOHN CRAIG EAVES (CEO)
- **Authorized official phone:** (505) 843-8758

## Contact information

- **Practice address:** 3810 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4479
- **Practice address phone:** (505) 843-8758
- **Practice address fax:** (505) 843-9269
- **Mailing address:** 3810 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4479
- **Mailing address phone:** (505) 843-8758
- **Mailing address fax:** (505) 843-9269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |
| 2080S0012X | Pediatric Sleep Medicine Physician | — | NULL | — |
| 2080S0012X | Pediatric Sleep Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 06/18/2009
- **Last updated:** 05/07/2024