Provider Demographics
NPI:1235215005
Name:ARK-LA-TEX SLEEP DISORDERS LAB
Entity Type:Organization
Organization Name:ARK-LA-TEX SLEEP DISORDERS LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CRRT
Authorized Official - Phone:903-791-6206
Mailing Address - Street 1:5604 SUMMERHILL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4652
Mailing Address - Country:US
Mailing Address - Phone:903-791-6206
Mailing Address - Fax:903-791-6135
Practice Address - Street 1:5604 SUMMERHILL RD STE 5
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4652
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:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTS005Medicare ID - Type UnspecifiedINDEPENDENT DIAGNOSTIC