1861772675 NPI number — TEXAS SLEEP CLINIC - BT PLLC

Table of content: (NPI 1861772675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861772675 NPI number — TEXAS SLEEP CLINIC - BT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS SLEEP CLINIC - BT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEXAS SLEEP CLINIC-BT PLLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861772675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13901 TECHNOLOGY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73134-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-606-2727
Provider Business Mailing Address Fax Number:
405-606-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 HOSPITAL DR STE 235
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-4654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-790-7841
Provider Business Practice Location Address Fax Number:
409-813-2382
Provider Enumeration Date:
08/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DONAGHUE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICER
Authorized Official Telephone Number:
405-606-2727

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OOH54K . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DU8610 . This is a "GROUP PTAN" identifier . This identifiers is of the category "OTHER".




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