Provider Demographics
NPI:1558452375
Name:MILAM PARK SLEEP CENTER
Entity Type:Organization
Organization Name:MILAM PARK SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-6000
Mailing Address - Street 1:5290 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4849
Mailing Address - Country:US
Mailing Address - Phone:210-614-6000
Mailing Address - Fax:210-614-7728
Practice Address - Street 1:343 W HOUSTON
Practice Address - Street 2:SUITE C-3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205
Practice Address - Country:US
Practice Address - Phone:210-614-6000
Practice Address - Fax:210-614-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730764-01Medicaid
TX1730764-01Medicaid