1194096982 NPI number — EAST SIDE SLEEP CENTER, LLC

Table of content: (NPI 1194096982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194096982 NPI number — EAST SIDE SLEEP CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SIDE SLEEP CENTER, LLC
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:
TOMBALL SLEEP CENTER
Provider Other Organization Name Type Code:
3
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:
1194096982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77497-2569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-207-8800
Provider Business Mailing Address Fax Number:
713-660-0970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 HOLDERRIETH BLVD
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-207-8889
Provider Business Practice Location Address Fax Number:
713-660-0970
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RICHEY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-664-1330

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)

  • Identifier: TXB155001 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 318162001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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