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General NPI Number Information
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NPI Number | 1871961326
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Entity Type | Organization
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Legal Business Name | BARIATRIC SLEEP CENTER LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 3635 BROADWAY BLVD STE C
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City | GARLAND
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State | TX
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Zip | 75043-1675
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Country | US
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Telephone | 214-932-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 3635 BROADWAY BLVD STE C
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City | GARLAND
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State | TX
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Zip | 75043-1675
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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 | MEMBER
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Name | THOMAS GOODALE
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Credential |
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Telephone | 214-932-6202
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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 | 32040572821
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License Number State | TX
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