MEDICARE: BAY BROOK SLEEP CENTER

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	246ZE0500X	EEG Specialist/Technologist
2	246ZA2600X	Medical Art Specialist/Technologist

General Provider Information

NPI Number	:	1891265633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY BROOK SLEEP CENTER

Provider Business Mailing Address
First Line	:	PO BOX 132904
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-2904
Country	:	US
Telephone Number	:	832-813-8280
Fax Number	:	800-500-2344

Provider Business Practice Location Address
First Line	:	1235 CLEAR LAKE CITY BLVD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8125
Country	:	US
Telephone Number	:	281-661-8209
Fax Number	:	281-661-1025

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	STEVE ROPHAIL
Credential	:
Telephone Number	:	713-679-4487

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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