Provider Demographics
NPI:1194096982
Name:EAST SIDE SLEEP CENTER, LLC
Entity type:Organization
Organization Name:EAST SIDE SLEEP CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-664-1330
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2569
Mailing Address - Country:US
Mailing Address - Phone:281-207-8800
Mailing Address - Fax:713-660-0970
Practice Address - Street 1:425 HOLDERRIETH BLVD
Practice Address - Street 2:210
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4543
Practice Address - Country:US
Practice Address - Phone:281-207-8889
Practice Address - Fax:713-660-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155001OtherMEDICARE
TX318162001Medicaid