Provider Demographics
NPI:1871866418
Name:EXTRA SENSORY TECHNOLOGY, L.C.
Entity Type:Organization
Organization Name:EXTRA SENSORY TECHNOLOGY, L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-614-8414
Mailing Address - Street 1:9005 LODGE CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6527
Mailing Address - Country:US
Mailing Address - Phone:512-614-8414
Mailing Address - Fax:
Practice Address - Street 1:9005 LODGE CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6527
Practice Address - Country:US
Practice Address - Phone:512-614-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment