1720218399 NPI number — SOUTH TEXAS SLEEP DISORDER CLINIC

Table of content: (NPI 1720218399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720218399 NPI number — SOUTH TEXAS SLEEP DISORDER CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS SLEEP DISORDER CLINIC
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:
1720218399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 E RIDGE RD
Provider Second Line Business Mailing Address:
STE. E.
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78503-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-682-8685
Provider Business Mailing Address Fax Number:
956-682-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 S CAROLINA ST
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-421-5665
Provider Business Practice Location Address Fax Number:
956-421-5652
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
METCALFE
Authorized Official First Name:
HARLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
913-706-7600

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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