Basic Information
| Provider Information | |||||||||
| NPI: | 1962712091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP MEDICINE CONSULTANTS OF CENTRAL TEXAS, PLLC | ||||||||
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| OtherOrganizationName: | THE SLEEP CENTER OF AUSTIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5508 PARKCREST DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209944 | ||||||||
| Practice Location | |||||||||
| Address1: | 5508 PARKCREST DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2010 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5124209900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | D0915 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.