Provider Demographics
NPI:1699843748
Name:SOUTHEAST TEXAS SLEEP DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS SLEEP DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-706-7600
Mailing Address - Street 1:1112 N. HIGHWAY 69
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627
Mailing Address - Country:US
Mailing Address - Phone:409-727-7122
Mailing Address - Fax:409-727-8080
Practice Address - Street 1:1112 N. HIGHWAY 69
Practice Address - Street 2:SUITE A
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627
Practice Address - Country:US
Practice Address - Phone:409-727-7122
Practice Address - Fax:409-727-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPL7097OtherBCBS
FT5061Medicare ID - Type Unspecified
TXFTS061Medicare PIN