MEDICARE: COMPLETE SLEEP MANAGEMENT INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P7131	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1386652287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE SLEEP MANAGEMENT INC

Provider Business Mailing Address
First Line	:	2931 OAK PARK CIR
Second Line	:	STE B
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1891
Country	:	US
Telephone Number	:	817-924-3000
Fax Number	:	817-924-3010

Provider Business Practice Location Address
First Line	:	2931 OAK PARK CIR
Second Line	:	STE B
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1891
Country	:	US
Telephone Number	:	817-924-3000
Fax Number	:	817-924-3010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRADLEY DOUGLAS WARREN
Credential	:
Telephone Number	:	817-924-3000

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	10/16/2014

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