1356417331 NPI number — PROGRESSIVE SLEEP DIAGNOSTIC, LLC

Table of content: (NPI 1356417331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356417331 NPI number — PROGRESSIVE SLEEP DIAGNOSTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE SLEEP DIAGNOSTIC, 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:
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:
1356417331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2421 WILCOX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-3956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-265-3100
Provider Business Mailing Address Fax Number:
405-253-4148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S MUSTANG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUKON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73099-7316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-265-3100
Provider Business Practice Location Address Fax Number:
405-253-4148
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKENZIE
Authorized Official First Name:
MEAGHAN
Authorized Official Middle Name:
RHEA
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
405-265-3100

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)





Copyright © 2007-2024 www.npivalidator.com