Provider Demographics
NPI:1053319012
Name:SLEEP CENTER OF AMERICA AT NORMAN
Entity Type:Organization
Organization Name:SLEEP CENTER OF AMERICA AT NORMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-447-4702
Mailing Address - Street 1:2500 MCGEE DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6722
Mailing Address - Country:US
Mailing Address - Phone:405-447-6017
Mailing Address - Fax:405-447-6301
Practice Address - Street 1:2500 MCGEE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6722
Practice Address - Country:US
Practice Address - Phone:405-447-6017
Practice Address - Fax:405-447-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8005ZZ322Medicare ID - Type Unspecified