Provider Demographics
NPI:1235331844
Name:HEALTHLINE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:HEALTHLINE DIAGNOSTICS, INC.
Other - Org Name:TEXOMA SLEEP DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-813-0300
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2142
Mailing Address - Country:US
Mailing Address - Phone:903-813-0300
Mailing Address - Fax:903-891-0910
Practice Address - Street 1:4102 OLD JACKSBORO HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2747
Practice Address - Country:US
Practice Address - Phone:940-723-1100
Practice Address - Fax:940-723-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPL7084OtherBC PROVIDER NUMBER
TXFTS093Medicare PIN