Provider Demographics
NPI:1649812389
Name:GREAT PLAINS SLEEP SPECIALISTS LLC
Entity type:Organization
Organization Name:GREAT PLAINS SLEEP SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:918-577-6963
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74477-0893
Mailing Address - Country:US
Mailing Address - Phone:918-577-6963
Mailing Address - Fax:918-577-6965
Practice Address - Street 1:1317 S DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7013
Practice Address - Country:US
Practice Address - Phone:918-577-6963
Practice Address - Fax:918-577-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic