Provider Demographics
NPI:1053504043
Name:SLEEP EASY GULF COAST SLEEP DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:SLEEP EASY GULF COAST SLEEP DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-607-7293
Mailing Address - Street 1:PO BOX 6370
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-0370
Mailing Address - Country:US
Mailing Address - Phone:850-607-7293
Mailing Address - Fax:850-607-7321
Practice Address - Street 1:2475 E NINE MILE RD
Practice Address - Street 2:SUITE F
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7795
Practice Address - Country:US
Practice Address - Phone:850-607-7293
Practice Address - Fax:850-607-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3218OtherBCBS FLORIDA
AL59195542OtherBCBS ALABAMA
FLAL730Medicare PIN