Provider Demographics
NPI:1205839743
Name:SLEEP PHYSIOLOGY
Entity Type:Organization
Organization Name:SLEEP PHYSIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BACCUS
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, NPS, RPSGT
Authorized Official - Phone:940-591-1496
Mailing Address - Street 1:1213 BENT OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3300
Mailing Address - Country:US
Mailing Address - Phone:940-591-1496
Mailing Address - Fax:940-591-1698
Practice Address - Street 1:1213 BENT OAKS CT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3300
Practice Address - Country:US
Practice Address - Phone:940-591-1496
Practice Address - Fax:940-591-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTSP28Medicare ID - Type Unspecified