Provider Demographics
NPI:1720351216
Name:MOUNTAIN STAR SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:MOUNTAIN STAR SLEEP DIAGNOSTICS
Other - Org Name:MOUNTAIN VIEW SLEEP DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-566-4448
Mailing Address - Street 1:1020 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5412
Mailing Address - Country:US
Mailing Address - Phone:915-566-4448
Mailing Address - Fax:
Practice Address - Street 1:4625 ALABAMA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2519
Practice Address - Country:US
Practice Address - Phone:915-566-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TX1000898332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies