Provider Demographics
NPI:1083776165
Name:PERRY A SANFORD
Entity Type:Organization
Organization Name:PERRY A SANFORD
Other - Org Name:QUALITY CARE SLEEP DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:512-670-1212
Mailing Address - Street 1:1620 GRAND AVENUE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2184
Mailing Address - Country:US
Mailing Address - Phone:512-670-1212
Mailing Address - Fax:512-670-1540
Practice Address - Street 1:1620 GRAND AVENUE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2184
Practice Address - Country:US
Practice Address - Phone:512-670-1212
Practice Address - Fax:512-670-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RS0012X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172335501Medicaid
TX531127OtherBCBS
TXFTSP15OtherPTAN