Basic Information
| Provider Information | |||||||||
| NPI: | 1700118445 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL SLEEP DIAGNOSTICS, INC | ||||||||
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| OtherOrganizationName: | PROFESSIONAL SLEEP DIAGNOSTICS - PROCTORVILLE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CORPORATE CENTER DR | ||||||||
| Address2: | SUITE #600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002000 | ||||||||
| FaxNumber: | 3055002155 | ||||||||
| Practice Location | |||||||||
| Address1: | 5897 COUNTY ROAD 107 | ||||||||
| Address2: | |||||||||
| City: | PROCTORVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456698852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883190202 | ||||||||
| FaxNumber: | 3042548802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | BARGER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8004862620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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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 |
No ID Information.