1285234468 NPI number — SLOW WAVE, INC.

Table of content: (NPI 1285234468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285234468 NPI number — SLOW WAVE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLOW WAVE, INC.
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:
1285234468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26100 COUNTRYSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPICEWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78669-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-379-6269
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
617 N US 281
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654-5141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-220-5700
Provider Business Practice Location Address Fax Number:
830-220-5701
Provider Enumeration Date:
10/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-787-5589

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 76041759786540000 . This is a "TRICARE EAST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 901-51505 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 10078388 . This is a "CDRH FDA CLEARED SLOW WAVE, INC. SLOW WAVE DS8 ANTI-SNORING SLEEP APNEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: NG92V . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 535244 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: K191320 . This is a "CDRH FDA CLEARED K191320 SLOW WAVE, INC. MEDICAL DEVICE SLOW WAVE DS8" identifier . This identifiers is of the category "OTHER".




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