Flagler Diagnostic & Sleeping Disorder, Inc, Inc
Organization Active NPI Sleep Disorder Diagnostic Clinic/Center · Bunnell, FL
NPI 1013000652 · NPPES record last updated Mar 22, 2017
Key facts
- NPI
- 1013000652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sleep Disorder Diagnostic Clinic/Center 261QS1200X
- Legal business name
- FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
- Practice address
- 4721 E. Moody Blvd Suite 104
Bunnell, FL 32110 - Phone
- (386) 586-6229
- Fax
- (386) 263-2975
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kimberly L. Roches, CFE
- Title
- Facility Director
- Phone
- (386) 586-6229
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050209000516 | FL | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 2961453741 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bunnell, FL |
National Provider Directory
- Tax ID family
- Flagler Diagnostic and Sleeping Disorder Inc
Locations
4721 E Moody Blvd
Ste 104
Bunnell, FL 32110
Phone (386) 586-1229
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sleep Disorder Diagnostic Clinic/Center | 261QS1200X | Yes |
Addresses
Primary practice location
4721 E. Moody Blvd Suite 104
Bunnell, FL 32110
Mailing address
4721 E. Moody Blvd Suite 104
Bunnell, FL 32110
Phone (386) 586-6229
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V3019 | Other | FL | FL BLUE SHEILD |
| P00307040 | Other | FL | RAILROAD MEDICARE |
| 018211800 | Medicaid | FL |
Other providers in Bunnell, FL
- Flagler County Public Transportation
- Flagler County School Board
- Flagler County School Board
- Flagler County School Board
- Flagler County Tax Collector Ambulance
- Flagler Mental Health Center, PA
- Flagler Open Arms Services Inc
- Flagler Pines Operations LLC
- Florida Department of Health
- Florida Department of Health
All providers in Bunnell, FL · Sleep Disorder Diagnostic Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.