Healthcare Provider Details

I. General information

NPI: 1942223326
Provider Name (Legal Business Name): NEW TAMPA SLEEP CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 WINDGUARD CIR.
WESLEY CHAPEL FL
33543
US

IV. Provider business mailing address

615 W CARMEL DR SUITE 100
CARMEL IN
46032-2996
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-1080
  • Fax:
Mailing address:
  • Phone: 317-706-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIN HALL
Title or Position: LICENSING
Credential:
Phone: 317-706-1080