MEDICARE: DIAGNOSTIC SLEEP OF THE MEDICAL CENTER LLC

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1871920330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC SLEEP OF THE MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 62002
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77205-2002
Country	:	US
Telephone Number	:	281-319-4910
Fax Number	:	832-644-9503

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST
Second Line	:	STE 2280
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	281-319-4910
Fax Number	:	832-644-9503

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIM HENRY
Credential	:
Telephone Number	:	281-319-4910

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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