Provider Demographics
NPI:1508409707
Name:GULF COAST SLEEP CENTER AND DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:GULF COAST SLEEP CENTER AND DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-266-9497
Mailing Address - Street 1:107 W WAY ST STE 19
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5238
Mailing Address - Country:US
Mailing Address - Phone:979-266-9497
Mailing Address - Fax:979-266-9507
Practice Address - Street 1:107 W WAY ST STE 19
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5238
Practice Address - Country:US
Practice Address - Phone:979-266-9497
Practice Address - Fax:979-266-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic