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General NPI Number Information
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NPI Number | 1548751035
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Entity Type | Organization
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Legal Business Name | SOUTHERN INSTITUTE OF SLEEP MEDICINE PLLC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 1611 N BELT LINE RD STE C
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City | MESQUITE
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State | TX
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Zip | 75149-1792
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Country | US
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Telephone | 214-717-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 N BELT LINE RD STE C
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City | MESQUITE
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State | TX
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Zip | 75149-1792
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGELA FERGUSON
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Credential |
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Telephone | 214-717-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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