MEDICARE: SLEEP PHYSIOLOGY

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	291U00000X	Clinical Medical Laboratory	13	TX

General Provider Information

NPI Number	:	1205839743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP PHYSIOLOGY

Provider Business Mailing Address
First Line	:	1213 BENT OAKS CT
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-3300
Country	:	US
Telephone Number	:	940-591-1496
Fax Number	:	940-591-1698

Provider Business Practice Location Address
First Line	:	1213 BENT OAKS CT
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-3300
Country	:	US
Telephone Number	:	940-591-1496
Fax Number	:	940-591-1698

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JOHN ALAN BACCUS
Credential	:	CRT, NPS, RPSGT
Telephone Number	:	940-591-1496

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/21/2022

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Directions to “SLEEP PHYSIOLOGY ” Practice Location

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