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General NPI Number Information
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NPI Number | 1275720765
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Entity Type | Organization
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Legal Business Name | NOCTURNA OF GRANBURY, LP
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 805 HILL BLVD SUITE 107
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City | GRANBURY
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State | TX
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Zip | 76048-1481
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Country | US
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Telephone | 817-573-9619
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Fax | 817-573-9264
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Provider Business Mailing Address
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Address Line | PO BOX 248855 DEPT 22
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City | OKLAHOMA CITY
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State | OK
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Zip | 73124-8855
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Country | US
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Telephone | 405-600-1950
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Fax | 405-600-1949
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | LEWIS P ZEIDNER
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Credential |
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Telephone | 763-432-8401
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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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