Provider Demographics
NPI:1669759460
Name:EZ SLEEP MEDICAL CLINIC CORPORATION
Entity type:Organization
Organization Name:EZ SLEEP MEDICAL CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEISE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-943-9190
Mailing Address - Street 1:1212 COIT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7740
Mailing Address - Country:US
Mailing Address - Phone:972-943-9190
Mailing Address - Fax:972-943-9197
Practice Address - Street 1:1212 COIT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7740
Practice Address - Country:US
Practice Address - Phone:972-943-9190
Practice Address - Fax:972-943-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic