Provider Demographics
NPI:1780960468
Name:PONCA SLEEP INTERPRETORS LLC
Entity type:Organization
Organization Name:PONCA SLEEP INTERPRETORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRIKRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-762-7734
Mailing Address - Street 1:400 FAIRVIEW
Mailing Address - Street 2:SUITE10
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-762-7734
Mailing Address - Fax:580-762-6914
Practice Address - Street 1:400 FAIRVIEW
Practice Address - Street 2:SUITE10
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-762-7734
Practice Address - Fax:580-762-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21878174400000X
OK16078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty