Provider Demographics
NPI:1295939460
Name:SENTRY MEDICAL CORPORATION
Entity type:Organization
Organization Name:SENTRY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SAMP
Authorized Official - Suffix:
Authorized Official - Credentials:CPFT, RRT, RCP
Authorized Official - Phone:432-331-1492
Mailing Address - Street 1:855 CENTRAL DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4200
Mailing Address - Country:US
Mailing Address - Phone:432-331-1492
Mailing Address - Fax:432-331-1493
Practice Address - Street 1:855 CENTRAL DR
Practice Address - Street 2:SUITE 15
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4200
Practice Address - Country:US
Practice Address - Phone:432-331-1492
Practice Address - Fax:432-331-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51464293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory