1134305568 NPI number — ARK-LA-TEX SLEEP CENTER, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134305568 NPI number — ARK-LA-TEX SLEEP CENTER, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARK-LA-TEX SLEEP CENTER, LLP
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:
Provider Other Organization Name Type Code:
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:
1134305568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 GALLERIA OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-791-9120
Provider Business Mailing Address Fax Number:
903-791-9132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5604 SUMMERHILL RD
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-791-6206
Provider Business Practice Location Address Fax Number:
903-791-6135
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GREY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
903-791-9120

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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