Provider Demographics
NPI:1891020087
Name:SLEEP TESTING CENTER OF SOUTH TAMPA
Entity Type:Organization
Organization Name:SLEEP TESTING CENTER OF SOUTH TAMPA
Other - Org Name:RESTORE SLEEP CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-727-0782
Mailing Address - Street 1:2895 HWY 190
Mailing Address - Street 2:SUITE 223
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-727-0782
Mailing Address - Fax:985-727-0783
Practice Address - Street 1:215 NORTH HOWARD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-253-0004
Practice Address - Fax:813-902-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QS1200X
FLHCC3685261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic