MEDICARE: SOUTHERN SLEEP DIAGNOSTICS 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	174400000X	Specialist	0067810	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427117878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SLEEP DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	4764 RESEARCH DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-5002
Country	:	US
Telephone Number	:	210-614-9775
Fax Number	:	210-614-2891

Provider Business Practice Location Address
First Line	:	4764 RESEARCH DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-5002
Country	:	US
Telephone Number	:	210-614-9775
Fax Number	:	210-614-2891

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RALPH HUNTINGTON WINTON III
Credential	:	MR.
Telephone Number	:	210-364-0741

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/17/2021

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