Provider Demographics
NPI:1275670564
Name:AMERICAN SLEEP DIAGNOSTIC
Entity Type:Organization
Organization Name:AMERICAN SLEEP DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-404-0500
Mailing Address - Street 1:4490 BELTWAY DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3705
Mailing Address - Country:US
Mailing Address - Phone:970-404-0500
Mailing Address - Fax:972-404-0510
Practice Address - Street 1:4490 BELTWAY DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3705
Practice Address - Country:US
Practice Address - Phone:972-404-0500
Practice Address - Fax:972-404-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPL7014OtherBCBS OF TX
TXFTSP33Medicare ID - Type UnspecifiedSLEEP DISORDERS