Provider Demographics
NPI:1093843690
Name:ORANGE PARK SLEEP CENTER LLC
Entity Type:Organization
Organization Name:ORANGE PARK SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-269-0334
Mailing Address - Street 1:1542 KINGSLEY AVE
Mailing Address - Street 2:SUITE 132
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4586
Mailing Address - Country:US
Mailing Address - Phone:904-269-0334
Mailing Address - Fax:
Practice Address - Street 1:1542 KINGSLEY AVE
Practice Address - Street 2:SUITE 138
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4586
Practice Address - Country:US
Practice Address - Phone:904-269-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory