MEDICARE: SLEEP DIAGNOSTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	64071	TX

General Provider Information

NPI Number	:	1124274253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DIAGNOSTICS

Provider Business Mailing Address
First Line	:	PO BOX 507
Second Line	:
City	:	ELIOT
State	:	ME
Zip	:	03903-0507
Country	:	US
Telephone Number	:	936-520-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	19782 HIGHWAY 105 W
Second Line	:	STE 133
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-3103
Country	:	US
Telephone Number	:	936-520-0194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH MILLER
Credential	:	RRT
Telephone Number	:	936-520-0194

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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Directions to “SLEEP DIAGNOSTICS ” Practice Location

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