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General NPI Number Information
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NPI Number | 1194958447
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SLEEP DIAGNOSTIC CENTERS NORTH LLC
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 8701 OLD TROY PIKE SUITE 210
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-1066
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Country | US
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Telephone | 937-610-0105
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Fax | 937-610-0109
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Provider Business Mailing Address
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Address Line | 7756 WASHINGTON VILLAGE DR SUITE A
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City | CENTERVILLE
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State | OH
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Zip | 45459-3953
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Country | US
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Telephone | 937-610-0105
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Fax | 937-610-0109
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. JERRY CARR
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Credential |
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Telephone | 937-610-0105
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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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