Provider Demographics
NPI:1881210599
Name:SLEEP DOCTOR PLLC
Entity Type:Organization
Organization Name:SLEEP DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-908-6474
Mailing Address - Street 1:1500 FINSTERWALD PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6011
Mailing Address - Country:US
Mailing Address - Phone:817-209-4946
Mailing Address - Fax:
Practice Address - Street 1:840 E REDD RD BLDG 1A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7265
Practice Address - Country:US
Practice Address - Phone:915-701-6725
Practice Address - Fax:915-995-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS3791OtherMEDICAL LICENSE