Provider Demographics
NPI:1013000652
Name:FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Entity Type:Organization
Organization Name:FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROCHES
Authorized Official - Suffix:
Authorized Official - Credentials:CFE
Authorized Official - Phone:386-586-6229
Mailing Address - Street 1:4721 E. MOODY BLVD SUITE 104
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110
Mailing Address - Country:US
Mailing Address - Phone:386-586-6229
Mailing Address - Fax:386-263-2975
Practice Address - Street 1:4721 E. MOODY BLVD SUITE 104
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110
Practice Address - Country:US
Practice Address - Phone:386-586-6229
Practice Address - Fax:386-263-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3019OtherFL BLUE SHEILD
FLP00307040OtherRAILROAD MEDICARE
FL018211800Medicaid
FL018211800Medicaid