MEDICARE: NORTH TEXAS LUNG & SLEEP CLINIC PA

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	207RP1001X	Pulmonary Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH3974	OTHER		MEDICARE RR GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00724N	OTHER	TX	BCBS GROUP

General Provider Information

NPI Number	:	1144271792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS LUNG & SLEEP CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 100189
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-0189
Country	:	US
Telephone Number	:	817-731-0230
Fax Number	:	817-731-7046

Provider Business Practice Location Address
First Line	:	2801 S HULEN ST
Second Line	:	SUITE 600
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1517
Country	:	US
Telephone Number	:	817-731-0230
Fax Number	:	817-731-7046

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID OSTRANSKY
Credential	:	DO
Telephone Number	:	817-731-0230

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/07/2007

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