1386685717 NPI number — ALL VALLEY SLEEP CENTER, LLC

Table of content: (NPI 1386685717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386685717 NPI number — ALL VALLEY SLEEP CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL VALLEY 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:
Provider Other Organization Name Type Code:
6
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:
1386685717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 985
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78589-0985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-702-9700
Provider Business Mailing Address Fax Number:
956-702-9704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5511 DOCTORS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-5563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-971-5510
Provider Business Practice Location Address Fax Number:
956-971-5509
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
NELLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING OFFICER
Authorized Official Telephone Number:
956-342-1632

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183899701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PL7160 . This is a "BLUE CROSS & BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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