Provider Demographics
NPI:1518212646
Name:THE GOOD SHEPHERD SLEEP CENTER
Entity Type:Organization
Organization Name:THE GOOD SHEPHERD SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-727-3587
Mailing Address - Street 1:13668 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635
Mailing Address - Country:US
Mailing Address - Phone:727-807-6969
Mailing Address - Fax:727-400-3292
Practice Address - Street 1:13668 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635
Practice Address - Country:US
Practice Address - Phone:727-807-6969
Practice Address - Fax:727-400-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QS1200X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV009DOtherBLUE CROSS BLUE SHIELD