Provider Demographics
NPI:1093735839
Name:MAINLAND AMERICAN SLEEP DIAGNOSTIC CENTER, INC.
Entity Type:Organization
Organization Name:MAINLAND AMERICAN SLEEP DIAGNOSTIC CENTER, INC.
Other - Org Name:SLEEP DIAGNOSTICS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-218-6990
Mailing Address - Street 1:17300 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2732
Mailing Address - Country:US
Mailing Address - Phone:281-218-6990
Mailing Address - Fax:281-218-7969
Practice Address - Street 1:17300 MERCURY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2732
Practice Address - Country:US
Practice Address - Phone:281-218-6990
Practice Address - Fax:281-218-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032MAOtherBLUE CROSS BLUE SHEILD
TXFTS296Medicare Oscar/Certification
TXFTP023Medicare Oscar/Certification