Provider Demographics
NPI:1053445163
Name:SLEEP DISORDER CENTERS, INC
Entity Type:Organization
Organization Name:SLEEP DISORDER CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CONTRACTING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-600-1950
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5576
Mailing Address - Country:US
Mailing Address - Phone:405-600-1950
Mailing Address - Fax:405-600-1949
Practice Address - Street 1:3613 NW 56TH ST
Practice Address - Street 2:SUITE 380
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4526
Practice Address - Country:US
Practice Address - Phone:405-600-1950
Practice Address - Fax:405-600-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKB5571Medicare PIN