Provider Demographics
NPI:1669640447
Name:HUNTSVILLE SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:HUNTSVILLE SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:SPIROS
Authorized Official - Last Name:MANTZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-293-8883
Mailing Address - Street 1:122 MEDICAL PARK LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4971
Mailing Address - Country:US
Mailing Address - Phone:936-293-8883
Mailing Address - Fax:
Practice Address - Street 1:122 MEDICAL PARK LANE
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4971
Practice Address - Country:US
Practice Address - Phone:936-293-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic