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General NPI Number Information
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NPI Number | 1194096982
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Entity Type | Organization
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Legal Business Name | EAST SIDE SLEEP CENTER, LLC
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 425 HOLDERRIETH BLVD 210
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City | TOMBALL
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State | TX
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Zip | 77375-4543
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Country | US
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Telephone | 281-207-8889
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Fax | 713-660-0970
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Provider Business Mailing Address
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Address Line | PO BOX 2569
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City | STAFFORD
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State | TX
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Zip | 77497-2569
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Country | US
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Telephone | 281-207-8800
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Fax | 713-660-0970
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TODD RICHEY
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Credential |
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Telephone | 713-664-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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