Basic Information
| Provider Information | |||||||||
| NPI: | 1639148265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARLAND WELLNESS DIAGNOSTICS | ||||||||
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| OtherOrganizationName: | AMERICAN WELLNESS DIAGNOSTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 TIMMONS LN | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770275926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138400808 | ||||||||
| FaxNumber: | 7138400881 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N SHILOH RD | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750426680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724878880 | ||||||||
| FaxNumber: | 9744878886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARENSCHIELD | ||||||||
| AuthorizedOfficialFirstName: | PAIGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2813818838 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | PL7093 | 01 | TX | BCBS | OTHER |