Provider Demographics
NPI:1275720765
Name:NOCTURNA OF GRANBURY, LP
Entity Type:Organization
Organization Name:NOCTURNA OF GRANBURY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-432-8401
Mailing Address - Street 1:PO BOX 248855
Mailing Address - Street 2:DEPT 22
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8855
Mailing Address - Country:US
Mailing Address - Phone:405-600-1950
Mailing Address - Fax:405-600-1949
Practice Address - Street 1:805 HILL BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1481
Practice Address - Country:US
Practice Address - Phone:817-573-9619
Practice Address - Fax:817-573-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTS197Medicare PIN