Provider Demographics
NPI:1073693263
Name:HOME SLEEP DIAGNOSTICS LTD.
Entity Type:Organization
Organization Name:HOME SLEEP DIAGNOSTICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:806-356-0009
Mailing Address - Street 1:PO BOX 51317
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1317
Mailing Address - Country:US
Mailing Address - Phone:806-356-0009
Mailing Address - Fax:
Practice Address - Street 1:3905 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4281
Practice Address - Country:US
Practice Address - Phone:806-356-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59304261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165263801Medicaid
TXPL7024OtherBCBS OF TEXAS PROVIDER #
TX165263801Medicaid