Provider Demographics
NPI:1093112518
Name:ACADEMY DIAGNOSTICS SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:ACADEMY DIAGNOSTICS SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTENBEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-659-0248
Mailing Address - Street 1:12727 KIMBERLEY LN STE 107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4047
Mailing Address - Country:US
Mailing Address - Phone:832-659-0248
Mailing Address - Fax:832-659-0261
Practice Address - Street 1:12727 KIMBERLEY LN STE 107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4047
Practice Address - Country:US
Practice Address - Phone:832-659-0248
Practice Address - Fax:832-659-0261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADEMY DIAGNOSTICS SLEEP CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195688001Medicaid
TX195688001Medicaid