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General NPI Number Information
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NPI Number | 1619231099
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Entity Type | Organization
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Legal Business Name | PRIME SLEEP SERVICES GROUP, LLC
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 6401 ELDORADO PKWY 304
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City | MCKINNEY
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State | TX
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Zip | 75070-5887
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Country | US
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Telephone | 214-620-2057
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Fax | 214-620-2058
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Provider Business Mailing Address
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Address Line | 6401 ELDORADO PKWY 304
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City | MCKINNEY
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State | TX
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Zip | 75070-5887
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Country | US
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Telephone | 214-620-2057
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Fax | 214-620-2058
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK GARDNER
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Credential | MD
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Telephone | 214-537-8039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 100912
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License Number State | TX
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