Provider Demographics
NPI:1396799375
Name:BRAZOS VALLEY SLEEP DIAGNOSTICS
Entity type:Organization
Organization Name:BRAZOS VALLEY SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:979-846-1026
Mailing Address - Street 1:PO BOX 3576
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-3576
Mailing Address - Country:US
Mailing Address - Phone:979-846-1026
Mailing Address - Fax:979-846-1041
Practice Address - Street 1:702 UNIVERSITY DR E
Practice Address - Street 2:STE. F-100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1896
Practice Address - Country:US
Practice Address - Phone:979-846-1026
Practice Address - Fax:979-846-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57013227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTS097Medicare PIN