Organization Name: | SPACE COAST SLEEP DISORDERS CENTER LLC |
NPI Number: | 1023037272 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANTONIO EDWIN STIGALL (PRESIDENT/CEO) |
Mailing Address: | 640 Classic Ct Suite 106 Melbourne |
State: | FL US |
Postal Code: | 329408279 |
Phone Number: | 3212559901 |
Fax Number: | 3212559902 |
NPI Enumeration Date: | 07/19/2006 |
NPI Last Update Date: | 10/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1200X |
License Number: | HCC7135 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Sleep Disorder Diagnostic |
Taxonomy Definition: |