Provider Demographics
NPI:1922276716
Name:SLEEP MEDICINE CONSULTANTS OF CENTRAL TEXAS, PLLC
Entity Type:Organization
Organization Name:SLEEP MEDICINE CONSULTANTS OF CENTRAL TEXAS, PLLC
Other - Org Name:PARKCREST MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:JOHN D HUDSON, MD
Authorized Official - Phone:512-420-9900
Mailing Address - Street 1:5508 PARKCREST DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4905
Mailing Address - Country:US
Mailing Address - Phone:512-600-6489
Mailing Address - Fax:
Practice Address - Street 1:5508 PARKCREST DR
Practice Address - Street 2:SUITE 212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4905
Practice Address - Country:US
Practice Address - Phone:512-600-6489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195525402Medicaid
6086610001Medicare NSC