Provider Demographics
NPI:1114983145
Name:PHYSICIANS ONE SLEEP CENTER, LP
Entity Type:Organization
Organization Name:PHYSICIANS ONE SLEEP CENTER, LP
Other - Org Name:PHYSICIANS ONE SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO & ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-621-4464
Mailing Address - Street 1:6300 RICHMOND AVENUE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5931
Mailing Address - Country:US
Mailing Address - Phone:713-621-4464
Mailing Address - Fax:713-219-4086
Practice Address - Street 1:6300 RICHMOND AVENUE
Practice Address - Street 2:SUITE 333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5931
Practice Address - Country:US
Practice Address - Phone:713-621-4464
Practice Address - Fax:713-219-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
TX261QS1200X
TX45D0932241291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01170655OtherAMERIGROUP TX INC
TX01170655OtherAMERIGROUP TX INC