Healthcare Provider Details

I. General information

NPI: 1710120027
Provider Name (Legal Business Name): SLEEP SOLUTIONS SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 89TH ST
OKLAHOMA CITY OK
73159-7900
US

IV. Provider business mailing address

409 E CALIFORNIA AVE
OKLAHOMA CITY OK
73104-4224
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-0060
  • Fax: 405-949-0412
Mailing address:
  • Phone: 405-949-0060
  • Fax: 405-949-0412

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: DR. TMOTHY MOORE
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 405-692-9300