Healthcare Provider Details

I. General information

NPI: 1528652112
Provider Name (Legal Business Name): PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W 26TH ST STE 206
HOUSTON TX
77008-1450
US

IV. Provider business mailing address

6071 E WOODMEN RD STE 225
COLORADO SPRINGS CO
80923-2611
US

V. Phone/Fax

Practice location:
  • Phone: 800-506-8933
  • Fax: 855-863-6522
Mailing address:
  • Phone: 719-638-1122
  • Fax: 719-638-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 719-638-1122