Provider Demographics
NPI:1265586689
Name:ALICE SLEEP LAB INC
Entity type:Organization
Organization Name:ALICE SLEEP LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:361-664-1042
Mailing Address - Street 1:PO BOX 7751
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78467-7751
Mailing Address - Country:US
Mailing Address - Phone:361-664-1042
Mailing Address - Fax:361-664-1091
Practice Address - Street 1:411 FLOURNOY RD
Practice Address - Street 2:STE 200
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4084
Practice Address - Country:US
Practice Address - Phone:361-664-1042
Practice Address - Fax:361-664-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162589901Medicaid
TXPL7181OtherBCBS
TXFTS048Medicare ID - Type Unspecified