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General NPI Number Information
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NPI Number | 1528303047
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Entity Type | Organization
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Legal Business Name | WICHITA FALLS SLEEP CENTER LLC
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 601 E 2ND ST SUITE E
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City | ODESSA
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State | TX
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Zip | 79761-5423
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Country | US
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Telephone | 432-337-6669
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Fax | 432-337-6665
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Provider Business Mailing Address
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Address Line | PO BOX 2406
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City | ODESSA
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State | TX
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Zip | 79760-2406
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Country | US
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Telephone | 432-337-6669
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Fax | 432-337-6665
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Authorized Official
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Title or Position | CONSULTANT
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Name | MR. SASIDHAR PAMGANAMAMULA
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Credential |
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Telephone | 765-537-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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