Provider Demographics
NPI:1932484409
Name:SLEEP TESTING CENTER OF WESLEY CHAPEL LLC
Entity Type:Organization
Organization Name:SLEEP TESTING CENTER OF WESLEY CHAPEL LLC
Other - Org Name:
Other - Org Type:
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 HIGHWAY 190
Mailing Address - Street 2:SUITE 223
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3414
Mailing Address - Country:US
Mailing Address - Phone:985-727-0782
Mailing Address - Fax:
Practice Address - Street 1:26851 TANIC DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4605
Practice Address - Country:US
Practice Address - Phone:813-907-4700
Practice Address - Fax:813-907-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZHCC9283261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic