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General NPI Number Information
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NPI Number | 1700992351
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Entity Type | Organization
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Legal Business Name | PHYSICIAN DIAGNOSTICS SLEEP TECHNOLOGY SPECIALISTS LLC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 900 W SOUTH BOUNDARY ST BUILDING 10
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City | PERRYSBURG
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State | OH
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Zip | 43551-5230
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Country | US
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Telephone | 419-872-3660
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Fax | 419-872-3662
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Provider Business Mailing Address
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Address Line | 900 W SOUTH BOUNDARY ST BUILDING 10
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City | PERRYSBURG
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State | OH
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Zip | 43551-5230
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Country | US
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Telephone | 419-872-3660
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Fax | 419-872-3662
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. MICHAEL J TAYLOR
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Credential | MS & ED, RRT
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Telephone | 419-872-3660
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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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