Provider Demographics
NPI:1700992351
Name:PHYSICIAN DIAGNOSTICS SLEEP TECHNOLOGY SPECIALISTS LLC
Entity Type:Organization
Organization Name:PHYSICIAN DIAGNOSTICS SLEEP TECHNOLOGY SPECIALISTS LLC
Other - Org Name:THE SLEEP DISORDERS CENTER OF PERRYSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS & ED, RRT
Authorized Official - Phone:419-872-3660
Mailing Address - Street 1:900 W SOUTH BOUNDARY ST
Mailing Address - Street 2:BUILDING 10
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5230
Mailing Address - Country:US
Mailing Address - Phone:419-872-3660
Mailing Address - Fax:419-872-3662
Practice Address - Street 1:900 W SOUTH BOUNDARY ST
Practice Address - Street 2:BUILDING 10
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5230
Practice Address - Country:US
Practice Address - Phone:419-872-3660
Practice Address - Fax:419-872-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4826100001Medicare NSC