MEDICARE: HEALTHLINE DIAGNOSTICS, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PL7084	OTHER	TX	BC PROVIDER NUMBER

General Provider Information

NPI Number	:	1235331844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHLINE DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2142
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75091-2142
Country	:	US
Telephone Number	:	903-813-0300
Fax Number	:	903-891-0910

Provider Business Practice Location Address
First Line	:	4102 OLD JACKSBORO HWY
Second Line	:	SUITE 200
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2747
Country	:	US
Telephone Number	:	940-723-1100
Fax Number	:	940-723-1133

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	EDWARD SIMS
Credential	:
Telephone Number	:	903-813-0300

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/24/2016

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