MEDICARE: NORTH TEXAS SLEEP LAB, L.L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1093764961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS SLEEP LAB, L.L.P.

Provider Business Mailing Address
First Line	:	5489 BLAIR RD
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75231-4179
Country	:	US
Telephone Number	:	214-739-6300
Fax Number	:	214-739-6305

Provider Business Practice Location Address
First Line	:	5489 BLAIR RD
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75231-4179
Country	:	US
Telephone Number	:	214-739-6300
Fax Number	:	214-739-6305

Authorized Official
Title or Position	:	PARTNER, OPERATIONS MANAGER
Name	:	MR. MATTHEW W THEDFORD
Credential	:	B.S., RPSGT
Telephone Number	:	214-739-6300

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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