Provider Demographics
NPI:1528303047
Name:WICHITA FALLS SLEEP CENTER LLC
Entity type:Organization
Organization Name:WICHITA FALLS SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:SASIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMGANAMAMULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-537-8696
Mailing Address - Street 1:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2406
Mailing Address - Country:US
Mailing Address - Phone:432-337-6669
Mailing Address - Fax:432-337-6665
Practice Address - Street 1:601 E 2ND ST
Practice Address - Street 2:SUITE E
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5423
Practice Address - Country:US
Practice Address - Phone:432-337-6669
Practice Address - Fax:432-337-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty