Provider Demographics
NPI:1558694224
Name:BIG BEND SLEEP CENTER, LLC
Entity type:Organization
Organization Name:BIG BEND SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY STOCK HOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GURRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-580-9700
Mailing Address - Street 1:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4100
Mailing Address - Country:US
Mailing Address - Phone:432-580-9700
Mailing Address - Fax:432-580-9703
Practice Address - Street 1:387 IH 10 W
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2700
Practice Address - Country:US
Practice Address - Phone:432-336-7000
Practice Address - Fax:432-368-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic