Provider Demographics
NPI:1619231099
Name:PRIME SLEEP SERVICES GROUP, LLC
Entity Type:Organization
Organization Name:PRIME SLEEP SERVICES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-537-8039
Mailing Address - Street 1:6401 ELDORADO PKWY
Mailing Address - Street 2:304
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5887
Mailing Address - Country:US
Mailing Address - Phone:214-620-2057
Mailing Address - Fax:214-620-2058
Practice Address - Street 1:6401 ELDORADO PKWY
Practice Address - Street 2:304
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5887
Practice Address - Country:US
Practice Address - Phone:214-620-2057
Practice Address - Fax:214-620-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100912332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100912OtherDEVICE DISTRIBUTOR LICENSE