Healthcare Provider Details

I. General information

NPI: 1013000652
Provider Name (Legal Business Name): FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 E. MOODY BLVD SUITE 104
BUNNELL FL
32110
US

IV. Provider business mailing address

4721 E. MOODY BLVD SUITE 104
BUNNELL FL
32110
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-6229
  • Fax: 386-263-2975
Mailing address:
  • Phone: 386-586-6229
  • Fax: 386-263-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY L. ROCHES
Title or Position: FACILITY DIRECTOR
Credential: CFE
Phone: 386-586-6229