Provider Demographics
NPI:1316186893
Name:FLAGLER DIAGNOSTIC AND SLEEPING DISORDER, INC.
Entity Type:Organization
Organization Name:FLAGLER DIAGNOSTIC AND SLEEPING DISORDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROCHES
Authorized Official - Suffix:
Authorized Official - Credentials:CFE, BS, AA
Authorized Official - Phone:386-586-6229
Mailing Address - Street 1:4721 E. MOODY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110
Mailing Address - Country:US
Mailing Address - Phone:386-586-6229
Mailing Address - Fax:386-263-2975
Practice Address - Street 1:1001 W. CYPRESS CREEK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-306-3760
Practice Address - Fax:877-537-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8433261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV0073OtherBCBS OF FL
FLV0073OtherBCBS
FL018211800Medicaid
FLU4182AMedicare UPIN