MEDICARE: SLEEP APNEA ASSOCIATES OF TEXAS, PLLC

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	122300000X	Dentist	19858	TX

General Provider Information

NPI Number	:	1467799601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP APNEA ASSOCIATES OF TEXAS, PLLC

Provider Business Mailing Address
First Line	:	200 MEDICAL PKWY
Second Line	:	SUITE 270
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1782
Country	:	US
Telephone Number	:	512-730-3623
Fax Number	:	512-367-5841

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY
Second Line	:	SUITE 270
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1782
Country	:	US
Telephone Number	:	512-730-3623
Fax Number	:	512-367-5841

Authorized Official
Title or Position	:	ORGANIZER
Name	:	SHANE E MATT
Credential	:	DMD
Telephone Number	:	512-730-3623

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	02/15/2013

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