| Organization Name: | SLEEP DISORDER CENTER FT WALTON BEACH INC |
| NPI Number: | 1164441309 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVE A RODGERS (LAB SUPERVISOR) |
| Mailing Address: | 151 Mary Esther Blvd Ste 203 Mary Esther |
| State: | FL US |
| Postal Code: | 325691985 |
| Phone Number: | 8506895496 |
| Fax Number: | 8506895497 |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 09/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Sleep Disorder Diagnostic |
| Taxonomy Definition: | |