Provider Demographics
NPI:1003092313
Name:PALESTINE HMS SLEEP LAB
Entity Type:Organization
Organization Name:PALESTINE HMS SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-675-9360
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-0512
Mailing Address - Country:US
Mailing Address - Phone:903-675-9360
Mailing Address - Fax:903-675-1570
Practice Address - Street 1:101 MOORE DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5909
Practice Address - Country:US
Practice Address - Phone:903-675-9360
Practice Address - Fax:903-675-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPL 7183OtherBCBS