1083634836 NPI number — REM SLEEP DIAGNOSTICS LLC

Table of content: (NPI 1083634836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083634836 NPI number — REM SLEEP DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REM SLEEP DIAGNOSTICS 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:
1083634836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-436-9055
Provider Business Mailing Address Fax Number:
936-436-9054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 MEDICAL CENTER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-436-9055
Provider Business Practice Location Address Fax Number:
936-436-9054
Provider Enumeration Date:
07/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DURAND
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
281-496-7667

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 530968 . This is a "BCBS TX (DME)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PL7063 . This is a "BLUECROSSBLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".