Provider Demographics
NPI:1376893925
Name:CERTIFIED SLEEP MEDICINE DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:CERTIFIED SLEEP MEDICINE DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:361-815-2301
Mailing Address - Street 1:5402 HOLLY RD
Mailing Address - Street 2:SUITE 2102
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4673
Mailing Address - Country:US
Mailing Address - Phone:361-815-2301
Mailing Address - Fax:
Practice Address - Street 1:5402 HOLLY RD
Practice Address - Street 2:SUITE 2102
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4673
Practice Address - Country:US
Practice Address - Phone:361-815-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX278605OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)