Healthcare Provider Details

I. General information

NPI: 1467698647
Provider Name (Legal Business Name): NORTHERN OKLAHOMA SLEEP DIAGNOSTIC CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W CHERRY AVE
ENID OK
73703-3318
US

IV. Provider business mailing address

2020 N WOODLAWN ST SUITE 470
WICHITA KS
67208-1852
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-8900
  • Fax: 580-237-8901
Mailing address:
  • Phone: 316-687-3071
  • Fax: 316-687-3056

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: GWENDOLYN KLUVER
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential: CPC
Phone: 316-687-3071