Provider Demographics
NPI:1124375688
Name:VITAL SLEEP OF AUSTIN
Entity Type:Organization
Organization Name:VITAL SLEEP OF AUSTIN
Other - Org Name:VITALSLEEP OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-0885
Mailing Address - Street 1:8835 LINE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6722
Mailing Address - Country:US
Mailing Address - Phone:318-222-0885
Mailing Address - Fax:318-222-0883
Practice Address - Street 1:9901 W IH 10 STE 800
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2292
Practice Address - Country:US
Practice Address - Phone:318-222-0885
Practice Address - Fax:512-901-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2011090631BP332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6734130001Medicare NSC