Provider Demographics
NPI:1972979482
Name:MAINLAND AMERICAN SLEEP DIAGNOSTICS CENTER, INC.
Entity type:Organization
Organization Name:MAINLAND AMERICAN SLEEP DIAGNOSTICS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENNON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:281-218-6990
Mailing Address - Street 1:PO BOX 580313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-0313
Mailing Address - Country:US
Mailing Address - Phone:281-218-6990
Mailing Address - Fax:281-218-7969
Practice Address - Street 1:401 W FAIRMONT PKWY
Practice Address - Street 2:STE F
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-218-6990
Practice Address - Fax:281-218-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001276332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX534039OtherBLUE CROSS
TX740032MAOtherBLUE CROSS
TX534039OtherBLUE CROSS
TXFTP023Medicare Oscar/Certification
TX182363501Medicaid