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General NPI Number Information
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NPI Number | 1780960468
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Entity Type | Organization
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Legal Business Name | PONCA SLEEP INTERPRETORS LLC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 400 FAIRVIEW SUITE10
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-762-7734
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Fax | 580-762-6914
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Provider Business Mailing Address
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Address Line | 400 FAIRVIEW SUITE10
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-762-7734
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Fax | 580-762-6914
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. SHRIKRISHNA V VAIDYA
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Credential | MD
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Telephone | 580-762-7734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21878
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16078
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License Number State | OK
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