MEDICARE: TEXAS CENTER FOR SLEEP DISORDERS AT WILLOW BEND LP

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

General Provider Information

NPI Number	:	1144481680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CENTER FOR SLEEP DISORDERS AT WILLOW BEND LP

Provider Business Mailing Address
First Line	:	210 PARK AVE
Second Line	:	SUITE 1350
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-5636
Country	:	US
Telephone Number	:	405-285-4914
Fax Number	:	405-285-7127

Provider Business Practice Location Address
First Line	:	5944 W PARKER RD STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6421
Country	:	US
Telephone Number	:	469-241-0081
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	LEWIS P ZEIDNER
Credential	:
Telephone Number	:	763-432-8401

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	01/27/2011

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