Provider Demographics
NPI:1134305568
Name:ARK-LA-TEX SLEEP CENTER, LLP
Entity Type:Organization
Organization Name:ARK-LA-TEX SLEEP CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-791-9120
Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-791-9120
Mailing Address - Fax:903-791-9132
Practice Address - Street 1:5604 SUMMERHILL RD
Practice Address - Street 2:#5
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-791-6206
Practice Address - Fax:903-791-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FTS185Medicare UPIN