Basic Information
| Provider Information | |||||||||
| NPI: | 1356371165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR SLEEP & MEDICAL DIAGNOSTICS INC | ||||||||
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| OtherOrganizationName: | PENSACOLA SLEEP DISORDERS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6706 N. 9TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325047398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504739709 | ||||||||
| FaxNumber: | 8504769519 | ||||||||
| Practice Location | |||||||||
| Address1: | 6706 N. 9TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325047398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504739709 | ||||||||
| FaxNumber: | 8504769519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | LOCKWOOD | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8504739709 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | HCC6992 | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.