Provider Demographics
NPI:1407031735
Name:ABOUDIB ADVANCED SLEEP CENTER
Entity Type:Organization
Organization Name:ABOUDIB ADVANCED SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABOUDIB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-568-9200
Mailing Address - Street 1:3304 SE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1108
Mailing Address - Country:US
Mailing Address - Phone:817-568-9200
Mailing Address - Fax:
Practice Address - Street 1:3304 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1108
Practice Address - Country:US
Practice Address - Phone:817-568-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic