MEDICARE: LUNGSTAR SLEEP 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

General Provider Information

NPI Number	:	1699770099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNGSTAR SLEEP DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1612 J PL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6117
Country	:	US
Telephone Number	:	972-422-4800
Fax Number	:	972-422-4333

Provider Business Practice Location Address
First Line	:	1612 J PL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-6117
Country	:	US
Telephone Number	:	972-422-4800
Fax Number	:	972-422-4333

Authorized Official
Title or Position	:	CEO
Name	:	MR. KYLE T KEITH SR.
Credential	:
Telephone Number	:	972-422-4800

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/22/2020

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