Provider Demographics
NPI:1629374517
Name:HUNTSVILLE SLEEP DME
Entity Type:Organization
Organization Name:HUNTSVILLE SLEEP DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANTZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-522-6836
Mailing Address - Street 1:122 MEDICAL PARK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4902
Mailing Address - Country:US
Mailing Address - Phone:936-522-6836
Mailing Address - Fax:936-293-8773
Practice Address - Street 1:122 MEDICAL PARK LN
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4902
Practice Address - Country:US
Practice Address - Phone:936-522-6836
Practice Address - Fax:936-293-8773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTSVILLE SLEEP CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies