Provider Demographics
NPI:1386658490
Name:PHYSICIAN SLEEP DIAGNOSTIC CENTERS, LLC
Entity Type:Organization
Organization Name:PHYSICIAN SLEEP DIAGNOSTIC CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-425-0035
Mailing Address - Street 1:7756 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3953
Mailing Address - Country:US
Mailing Address - Phone:937-425-0035
Mailing Address - Fax:937-425-8959
Practice Address - Street 1:7756 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3953
Practice Address - Country:US
Practice Address - Phone:937-425-0035
Practice Address - Fax:937-425-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPDID02991Medicare ID - Type Unspecified